Rotator Cuff
The rotator cuff is made up of four muscles-the supraspinatus, infraspinatus, subscapularis and teres minor. The rotator cuff muscles attach from the shoulder blade to the humerus. They help to keep your arm in the socket. Together, these muscles help to lift and rotate your arm. The most commonly injured rotator cuff muscle is the supraspinatus.
Rotator Cuff Anatomy
The rotator cuff is made up of four muscles-the supraspinatus, infraspinatus, subscapularis and teres minor. The rotator cuff muscles attach from the shoulder blade to the humerus. They help to keep your arm in the socket. Together, these muscles help to lift and rotate your arm. The most commonly injured rotator cuff muscle is the supraspinatus.
Supraspinatus
This muscle/tendon comes over the top of the shoulder and helps to move the arm in abduction (in a sideways arc). This is the most commonly torn tendon in the rotator cuff. Starts at the top of the shoulder blade and attaches to the top portion of the greater tuberosity on the head of the humerus
Subscapularis
This muscle/tendon of the rotator cuff attaches to the front of the shoulder and helps to turn the arm inwards (internal rotation). Starts on the front of the shoulder blade and attaches to the lesser tuberosity on the head of the humerus
Infraspinatus
This is the muscle/tendon comes across the back of the shoulder and helps to turn the arm outwards (external rotation). Starts on the middle part of the back of the shoulder blade and attaches to the middle portion of the greater tuberosity on the head of the humerus
Teres minor
This muscle/tendon also comes across the back of the shoulder and helps to turn the arm outwards when in abduction. Starts on the lower part of the back of the shoulder blade and attaches to the lowest portion of the greater tuberosity on the head of the humerus
Tendinitis
The rotator cuff is made up of four muscles-the supraspinatus, infraspinatus, subscapularis and teres minor. The rotator cuff muscles attach from the shoulder blade to the humerus. They help to keep your arm in the socket. Together, these muscles help to lift and rotate your arm. The most commonly injured rotator cuff muscle is the supraspinatus.
Tendinitis
Tendinitis is inflammation of the tendons of the rotator cuff. Muscles form into tendons at their point of attachment onto bone. Inflammation occurs when there is irritation due to either overuse of the shoulder or an injury to the shoulder. Sometimes tendinitis occurs without any known cause.
Tendinitis can be a very painful condition that limits a person’s ability to perform daily activities. It can last anywhere from a few weeks to several months.
Some symptoms of tendinitis include: pain in the shoulder and/or side of your upper arm, shoulder pain triggered by raising your arm or reaching behind your back, and shoulder pain that interferes with sleep. Tendinitis does not usually cause weakness.
Calcific Tendinitis
Calcific tendinitis occurs when calcium deposits build up in the rotator cuff muscles or tendons. The cause of developing calcific tendinitis is usually unknown. Sometimes having a prior injury to that shoulder can make you at higher risk for getting these calcium deposits. Calcific tendinitis has the same symptoms as regular tendinitis, but can often be more painful
Evaluation
Rotator cuff tendinitis is first evaluated by taking a history and performing an examination. We will evaluate your range of motion, measure strength and perform special tests to diagnose the source of your shoulder symptoms.
If warranted, we may order additional tests such as x-rays or MRI to confirm our diagnosis or rule out other conditions.
Management
Rotator cuff tendinitis is almost always managed with non-surgical treatments including:
- Rest and modification of activity
- Anti-inflammatory medication
- Physical therapy
Treatment options are determined based on factors such as: age, length of time symptoms have been present, and patient’s activity level.
Calcific tendinitis is typically treated in the same way as regular tendinitis. However, patients typically experience drastic improvement with an ultrasound-guided steroid injection.
As a last resort, surgical options are also available for treatment of these conditions.
Tears
The rotator cuff is made up of four muscles-the supraspinatus, infraspinatus, subscapularis and teres minor. The rotator cuff muscles attach from the shoulder blade to the humerus. They help to keep your arm in the socket. Together, these muscles help to lift and rotate your arm. The most commonly injured rotator cuff muscle is the supraspinatus.
Rotator Cuff Tears
Tears in the rotator cuff can occur in two different ways: a sudden/traumatic injury (acute tear) or degeneration over a period of time (chronic tear).
Acute tears are usually associated with immediate pain and/or weakness. These are usually caused by a single event that carries a high force, high impact. Most common causes of these types of tears are falling onto the arm or onto an outstretched arm, having the arm forcefully pulled away from the body.
Chronic or degenerative tears are the result of natural wear and tear associated with aging or activity. The likelihood of developing a degenerative rotator cuff tear increases with both age and/or repetitive stress to the shoulder (e.g. lifting, overhead work, baseball, tennis, housekeeping, etc.).
A partial thickness tear of a tendon means that only one portion of the tendon is torn.
A full thickness tear of a tendon means that the tendon is torn all the way through.
Symptoms
Some symptoms of both partial and full-thickness rotator cuff tears include: pain in the shoulder at rest and/or with shoulder movement, shoulder pain interfering with sleep, increased pain with lifting arm overhead, weakness with lifting or rotating your arm, weakness with lifting items.
Pain
The amount of pain is not related to the size of a tear. For example, very small tears can be very painful and large tears can not be painful at all. Sometimes pain can prevent you from being able to perform simple daily tasks.
Weakness
The amount of weakness is usually related to the size of a tear. Those with large tears usually have some degree of weakness and inability to lift the arm. However, for smaller tears, there may be no noticeable weakness. There are many other muscles in the shoulder that can compensate for torn a rotator cuff and help to lift and rotate your arm.
Evaluation
We will first evaluate if you have a rotator cuff tear by taking a history and performing an examination. We will evaluate your range of motion, measure strength and perform special tests to diagnose the source of your shoulder symptoms.
In order to accurately diagnose a tear, and the extent of the tear, an MRI is usually warranted to confirm our diagnosis or rule out other conditions.
Management
Not all rotator cuff tears require surgery. Some factors to consider in deciding the best course of treatment are:
- Size and type of tear
- Patient activity level
- Degree of pain and dysfunction
- Patient age
- Quality of muscle tissue.
Together, we make a mutual decision on whether to manage your condition surgically or conservatively without surgery.
Non-surgical treatment options include:
- Limiting movements that cause pain such as overhead activity
- Anti-inflammatory medication to reduce pain and swelling
- Physical therapy. Physical therapy can help relieve pain and restore function by strengthening the muscles that support the shoulder and by improving range of motion.
- Steroid injection may be an option for some patients, though is typically avoided in younger patients or those with certain medical comorbidities
Surgical Treatment is generally reserved for patients who:
- Have failed non-surgical options
- Have a traumatic or acute tear
- Have significant weakness or difficulty performing daily tasks.
- Have significant pain that interferes with daily life or sleep
