Over time, the rotator cuff tissue degenerates. This is in large part
due to
the blood supply of this tendon, which is somewhat limited. The rotator
cuff
tendon may also tear due to chronic repetitive trauma, or a single
traumatic
episode.
Rotator cuff tears can cause pain in the shoulder. This pain may be
felt deep
in the shoulder, or along the lateral arm. Rotator cuff pain may also
be
referred down the arm and patients may feel the pain along the upper arm,
or
even into the forearm or hand. When the rotator cuff tendons are torn,
the
shoulder may be weak. This weakness may also be accompanied by pain, when
trying
to lift objects or trying to use the arm overhead or in a forceful
manner. The
rotator cuff tear can often be diagnosed by physical examination;
however, magnetic
resonance imaging (MRI) of the shoulder can be helpful to
determine if the rotator
cuff is torn.
Symptomatic rotator cuff tears may be treated non-operatively or with
surgery.
If the symptoms have been going on a short time and there is no acute
trauma,
non-operative management may be appropriate. Non-operative management
includes
physical therapy, anti-inflammatory medication and/or cortisone
injection.
Rotator cuff repair surgery is appropriate for patients who have
longstanding
symptoms that do not respond to non-operative management. Surgery
is also appropriate
for rotator cuff tears that occur following trauma leading
to severe weakness
in a patient who had a previously normal shoulder. The
rotator cuff is repaired
to the bone using sutures to stitch the tendon back
into its normal position.
Rotator cuff surgery, when done technically well for
the appropriate patient,
has a high rate of success with the vast majority of
patients experiencing a
significant improvement.
After rotator cuff repair surgery, patients generally wear a sling for
their
arm for a total of six weeks. They have several months of physical
therapy to
recover their range of motion and strength. The vast majority of
patients experience
a significant improvement in their symptoms, when rotator
cuff repair surgery
is done appropriately for correctly selected patients.
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