Disorders of the Rotator Cuff
The rotator cuff are four muscles about the shoulder joint which aid in shoulder stability and serve as prime ‘movers’ of the ‘ball and socket’ or glenohumeral joint. The rotator cuff is particularly important in providing rotation strength to the shoulder. The cuff muscles attach to tendons, which, in turn attach to bone. The tendon has a relatively poor blood supply and is more prone to injury and ‘wear and tear’ than the muscular portion of the rotator cuff. The arthroscope is used to perform rotator cuff surgery when repair is indicated.
The two chief mechanisms, whereby rotator cuff injury occur, are trauma and generalized attrition/overuse. Sudden falls on the shoulder and dislocations of the joint can cause traumatic injury to the rotator cuff tendons. As we age, the tendons become significantly weaker and are much more prone to failure from trauma or overuse. In individuals over age 40, normal wear and tear changes more readily manifest, especially in those who frequently use their arms during overhead activity.
Rotator cuff tears are fairly common in those over age 60, yet not all tears are symptomatic. Pain may be present depending on the size and location of the tear and the activity status of the patient. Generally, any symptomatic full thickness tear in a younger (less than 50) will require surgical fixation. In older patients, a trial of rotator cuff rehab should be offered since strengthening muscles surrounding the tear may relieve symptoms. If more than one tendon is torn, the results of rehab are generally less successful. Larger tears, in general, can lead to cuff tissue atrophy or ‘shrinkage’ and are best treated with earlier repair.
Your surgeon may be trained to perform rotator cuff surgery arthroscopically, where the torn tissue is affixed to the humerus bone with instruments inserted through small punctures through the skin. In some cases, a larger incision is necessary, depending on the location and amount of retraction of the rotator cuff tear, and the experience of the surgeon. He or she may also shave done some overlying bone so that the cuff tendon is not subject to mechanical irritation or compression.
Generally the results of surgery are excellent with most patients enjoying significant reductions in pain. Return of strength depends on the quality of tissue and adequacy of repair. Unfortunately, tears neglected for long period of time may prove difficult to repair and may lead to premature arthritis of the joint. |
