DRUG INDEX
Rotator Cuff Disease
What is the rotator cuff?
The rotator cuff is the group of four tendons that stabilize the shoulder joint. The tendons hook up to the four muscles that move the shoulder in various directions.
The four muscles whose tendons form the rotator cuff are: the subscapularis muscle, which moves the arm by turning it inward (internal rotation); the supraspinatus muscle, which is responsible for elevating the arm and moving it away from the body; the infraspinatus muscle, which assists the lifting of the arm during turning the arm outward (external rotation); and the teres minor muscle, which also helps in the outward turning of the arm.
What is rotator cuff disease?
Rotator cuff disease is damage to the rotator cuff from any cause. This condition is one of the most common causes of shoulder pain.
How is the rotator cuff injured?
The rotator cuff can be injured because of degeneration with aging or inflammation due to tendinitis, bursitis , or arthritis of the shoulder. The rotator cuff is commonly injured by trauma (such as from falling and injuring the shoulder or overuse in sports). Rotator cuff injury is particularly common in persons who perform repetitive overhead motions that can stress the rotator cuff. These motions are frequently associated with muscle fatigue.
What are symptoms of rotator cuff disease?
The most common symptom of rotator cuff disease is shoulder pain. The pain is often noticed gradually and may be first noticed even a day after the actual event which may have caused the injury. Sometimes, a sudden pain occurs during a sport activity. The pain is usually located to the front and side of the shoulder and is increased when the shoulder is moved away from the body. The pain is usually noted to be more intense at nighttime and sometimes increases when lying on the affected shoulder.
Persons with rotator cuff disease usually find it difficult to lift the arm away from the body fully. If the rotator cuff disease involves severe tears of the rotator cuff tendons, it can be impossible for the patient to hold the arm up because of pain.
How is rotator cuff disease diagnosed?
Rotator cuff disease is suggested by the patient's history of activities and symptoms of pain in the shoulder described above. In making a diagnosis, the doctor can observe increased pain with maneuvers of the shoulder. The pain is due to local inflammation and swelling in the injured tendons of the rotator cuff. Additionally, with severe tendon tears of the rotator cuff, the arm falls due to weakness (positive drop sign) when moved away from the body.
The diagnosis of rotator cuff disease can be objectively confirmed by radiology testing. Sometimes plain x-rays can show bony injuries which suggest long-standing severe rotator cuff disease when it has been present for some time. An arthrogram involves injecting contrast dye into the shoulder joint to detect leakage out of the injured rotator cuff. The MRI is a non-invasive imaging test which uses a giant magnet and computer to produce fine images of the tissues of the shoulder. An MRI has the added advantage of providing more information than either X-ray or an arthrogram, especially if a condition other than rotator cuff disease is present.
How is rotator cuff disease treated?
The treatment of rotator cuff disease depends on the severity of the injury to the tendons of the rotator cuff and the underlying condition of the patient.
Mild rotator cuff disease is treated with ice, rest, and anti- inflammatory medications (such as ibuprofen and others). Generally, a gradual exercise rehabilitation is instituted. Exercises are used that are specifically designed for rotator cuff strengthening.
Patients with persistent pain and motion limitation can often benefit by a cortisone injection in the rotator cuff. Sometimes, repeat injections are necessary.
More severe rotator cuff disease can require surgical repair.
Subacromial decompression is the removal of a small portion of the bone (acromion) that overlies the rotator cuff. This removal can relieve pressure on the rotator cuff in certain conditions and promote healing and recovery. This procedure can be done by arthroscopic or open surgical techniques. Both methods have been reported to be equally successful.
The most severe rotator cuff disease, complete full-thickness rotator cuff tears, usually requires surgical procedures for the best results. These procedures, which can also be done by either arthroscopy or open surgery, involve mending the torn rotator cuff by suturing the tissues back together.
What is the outlook (prognosis) for rotator cuff disease?
Without treatment, including exercise, the shoulder frequently permanently loses full function from rotator cuff disease. Sometimes, scarring around the shoulder (adhesive capsulitis) leads to a marked restriction of the range of shoulder motion. This condition is referred to as a frozen shoulder.
Weeks of rehabilitation is the norm with significant rotator cuff disease. Some patients never recover full function of the shoulder joint. - The rotator cuff is a group of four tendons.
- Rotator cuff disease is one of the most common causes of shoulder pain.
- The rotator cuff can be injured by degeneration, inflammation, or trauma.
- The diagnosis of rotator cuff disease can be confirmed by radiology testing.
- The treatment of rotator cuff disease depends on the severity of the injury to the tendons of the rotator cuff.
Author: William C. Shiel Jr., MD, FACP, FACR
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