A rotator cuff tear is a very common condition treated by an orthopaedic surgeon. The incidence of rotator cuff injuries increases as we age due to degeneration and weakening of the underlying struc-tures.
The rotator cuff is comprised of 4 muscles that join together as tendons over the upper end of the hu-merus. The rotator cuff allows the arm to be lifted and rotated.
Problems with the rotator cuff can occur for various reasons. A fall onto an outstretched arm or exces-sive forces that result from lifting something heavy. Rotator cuff injuries often result from sports activi-ties and from motor vehicle accidents. The more common mechanism of rotator cuff injury is a degen-erative type tear. In this scenario, wear and tear results from natural aging. Repetitive stress, muscular imbalances and developed of bone spurs can cause tendon wear and a condition known as shoulder impingement. Over time this can lead to a degenerative tear.
Of the four tendons that comprise the rotator cuff, the supraspinatus is most commonly affected espe-cially in patients over 40 years old. Multiple tendons may be involved. Risks increase with repetitive overhead activity and with overuse.
Patients with a rotator cuff injury will typically present with complaints of pain to the affected shoulder especially with use of the arm. Elevating the arm may be difficult. Many will complain of pain at night if lying on the shoulder. Weakness may also be present. An acute tear often results in a sudden onset of severe pain.
A focused history and physical examination by an orthopaedic surgeon can identify if a rotator tear may be present. Specific tests on the physical examination help the surgeon identify what structures may be affected. An MRI may be ordered to evaluate the rotator cuff and surrounding structures.
Treatment for a rotator cuff tear may be non-surgical or surgical. Typically, non-surgical options are tried first including activity modification, the use of NSAID medications, and physical therapy. A corticoster-oid injection may also be offered to decrease pain and inflammation.
Surgical treatment may be recommend if a patient fails to improve with non-surgical treatments or has significant deficits. Surgery for a rotator cuff tear involves reattaching the torn tendon(s). Surgical ap-proaches include arthroscopic, open repair, and mini-open. Each approach has its advantages and disad-vantages. A structured rehabilitation program is required following surgery to regain mobility, strength, and return to function.