The rotator cuff is comprised of four muscles which stabilizes the shoulder joint and allows arms to freely rotate: the subscapularis, teres minor, supraspinatus, and infraspinatus. They attach the shoulder blade (scapula) to the upper arm bone (humerus). The rotator cuff muscles are responsible for most of the upper arm’s movement, including lifting and rotating the arm. The rotator cuff is also critical for keeping the “shoulder in its socket” (the upper arm securely resting against the shoulder blade). Deliberately strengthening the muscles surrounding the rotator cuff may produce an imbalance of muscle power that results in the inability of rotator cuff tendons to properly buttress the joint during vigorous physical activity. In addition, injured rotator cuff tissues regularly become wedged between the acromion and the humerus, causing pain and inflammation.
The rotator cuff function is to power the shoulder and also to maintain the center of rotation of the humeral head on the glenoid. As mentioned, the glenoid is a relatively shallow socket and does not provide enough coverage of the head to make the joint stable.
The labrum and ligaments are passive stabilizing features of the anatomy whereby the rotator cuff is a dynamic stabilizer and functions also to maintain the humeral head center of rotation properly oriented relative to the center of the glenoid.
It does this by drawing the humeral head into the glenoid cavity creating what is called concavity-compression. The rotator cuff also functions to move the humerus through space with the supraspinatus active primarily in abduction and flexion, the subscapularis in internal rotation and the infraspinatus and teres minor in external rotation.
In a rotator cuff tear, one or more of the tendons of the rotator cuff muscles are torn and are no longer fully functional. A rotator cuff tear may be partial or full thickness, depending on the degree in which the tendon has separated from the bone. Developing arthritis and bursitis may also be culprits of rotator cuff pain.
Rotator cuff tears often cause pain and weakness, though they may not cause any symptoms at all. If pain does occur, lifting or lowering the arm can bring on the pain, though it can also occur at rest and at night, especially when sleeping on the injured shoulder. People with rotator cuff tears often experience weakness when they try to lift or rotate the arm. In NYC (New York City, Staten Island, Jersey City) the rotator cuff tear doctors at Regional Orthopedic can perform physical examination tests that can diagnose rotator cuff tears. An ultrasound or MRI may be necessary to confirm the diagnosis and to plan rotator cuff tear treatment. The diagnosis of a shoulder rotator cuff injury is based on history and clinical exam. MRI is the definitive test which will demonstrate a tear. MRI examination can also show associated pathology including such things as impingement, labrum tearing, biceps tendon tearing, fatty infiltration of the rotator cuff muscles etc.
Rotator cuff tearing can be partial or complete. Partial thickness rotator cuff tearing can occur on the bursal surface, articular surface, or both.
Bursal sided tears are more often related to subacromial impingement by the direct influence of the external compression from the adjacent bone surfaces. The articular sided tears are more often related to repetitive stress and unrelated to impingement. The acronym for these tears is PASTA= partial articular sided tendon.
Full thickness tears are either non-retracted or retracted. Retracted tears can be mildly, moderately, or severely retracted. Tear patterns also include the shape of the tear and crescent tears, U shaped tears and longitudinal tears are examples of common tear patterns.
There are two categories of rotator cuff tears, acute and degenerative. An acute rotator cuff tear is caused by injury. For example, the injured person falls on an outstretched arm or tries to forcefully lift something well beyond their strength limitations. Degenerative rotator cuff tears are caused by long-standing wear and tear on the shoulder joint. They are most common in middle-aged individuals who spent a great deal of time performing the same arm motion repetitively, such as throwing a baseball, swinging a tennis racket, or rowing a boat. Bone spurs and blood supply abnormalities may also lead to degenerative rotator cuff tears.
Rotator cuff disease generally affects individuals over 40. Initially emerging from inflammation and/or bursitis of the shoulder, this disease eventually advances to tendons experiencing small tears and finally full thickness tears. Tendon degeneration is the usual cause of rotator cuff disease, but individuals may not realize the extent of the disease until debilitating symptoms begin occurring, such as an inability to raise their arms or perform certain movements. Rotator cuff disease may be accompanied by severe nighttime pain or frozen shoulder.
Rotator cuff tear treatment may be surgical or nonsurgical. Indeed, many partial thickness rotator cuff tears may heal without surgery. Nevertheless, people who have chronic arm pain, weakness, or who are unable to lift their shoulder or arm should speak with a rotator cuff tear doctor to discuss treatment options.
Physical therapy is the main nonsurgical rotator cuff tear treatment. The physical therapist will help the patient identify ways to avoid further injuring the shoulder and recommend stretching and strengthening exercises to improve shoulder function.
Other nonsurgical rotator cuff tear treatments include steroid injections into the shoulder and nonsteroidal anti-inflammatory medications (NSAIDs). While nonsurgical treatments can be effective, the rotator cuff tear may get bigger over time.
If nonsurgical treatments fail to relieve symptoms, a rotator cuff tear surgeon may perform a surgical procedure to repair the tendon. Rotator cuff repair can be performed as an open procedure or arthroscopically. Open surgery can be classified as either standard or “mini open” depending on the size of the incision. Standard open surgery involves a large skin incision and is rarely performed. A mini open approach uses a smaller incision and allows the rotator cuff tear surgeon to see the entire surgical field. Most patients opt for arthroscopic surgery when it is possible. In any of the three techniques, the rotator cuff repair surgeon will suture the damaged ends of the tendon to the upper arm bone.
If you think you may have a rotator cuff tear, contact the top rotator cuff tear surgeons in New York City. Regional Orthopedics has offices in New York City, Staten Island, and Jersey City.