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 Jose A. Padilla, MD |
Rotator Cuff DiseaseJose A. Padilla, MD One of the most common problems that I see is shoulder pain. Rotator cuff disease is one of the most common diagnoses made during such visits. The rotator cuff is a group of four tendons that surround the top of the arm bone at the shoulder (see Figure 2). These muscles move the shoulder in various directions. Injury to the rotator cuff can lead to an inability to use the arm satisfactorily. The rotator cuff can suffer injury from three basic causes: degeneration with aging, inflammation such as tendinitis and bursitis, or with trauma such as from sports or work. Rotator cuff injuries are commonly seen in persons who perform repetitive overhead motions. Although rotator cuff injuries are most often seen in late middle-age patients, they can be seen at any age.
Causes Rotator cuff tissue often has a rather poor blood supply. This allows degenerative problems to worsen and turn into full tears. This is even more pronounced when people have diabetes or smoke cigarettes. People with repetitive overhead jobs, who participate in overhead sports such as volleyball or baseball, or perform repetitive chores around the house can develop rotator cuff injuries. I frequently see patients for sudden injuries to their shoulders, such as a fall or trying to stop something from falling. They are some of the most dramatic cases because people literally lose the ability to lift their arm in the span of a second.
Symptoms Patients might complain of sudden pain or gradual pain that has worsened. Sometimes people forget that a day or two before the pain started they had actually been busy cleaning or painting a room in the house. Most patients complain that the pain is worse at night, especially if they try to sleep on the affected side. They remark that it is difficult to hold things out at arm’s length and some people feel that there’s a “catch” in their shoulder.
Diagnosis The diagnosis of any medical problem starts with the physician taking a detailed history. A physical exam and x-rays often firm up the diagnosis.
very accurate.
Treatment Treatment centers on controlling the inflammation. Rest, ice and anti-inflammatory medicines are first line treatments. Therapy, exercises and cortisone injections might also be prescribed to assist the patient in recovering from their rotator cuff injuries. However, if these options are not successful, your doctor may suggest surgery. Surgery is designed to either remove pressure on the rotator cuff, i.e., removing bone spurs or creating space underneath a bone called the acromion, or to repair torn tissue. The surgery can be done either using the traditional open incision technique or arthroscopically, utilizing small incisions and cameras.
Following surgery, your surgeon will outline an intensive rehabilitation
Summary Rotator cuff injuries lead to significant loss of function. A thorough evaluation can assist in finding the best path to recovery. Although surgery and the recovery process can take many months, it may be the best option. Your orthopedist is the best resource for explaining possible options and outcomes for your particular shoulder problem.
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