ROTATOR CUFF TEAR

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The rotator cuff is a group of muscles and tendons that surround the shoulder joint, keeping the head of your upper arm bone firmly within the shallow socket of the shoulder. A rotator cuff injury can cause a dull ache in the shoulder, which often worsens with use of the arm away from the body.

Rotator cuff injuries are common and increase with age. These may occur earlier in people who have jobs that require repeatedly performing overhead motions. Examples include painters and carpenters.

Many people with rotator cuff disease can manage their symptoms and return to activities with physical therapy exercises that improve flexibility and strength of the muscles surrounding the shoulder joint.

Sometimes, rotator cuff tears may occur as a result of a single injury. In those circumstances, medical evaluation should be provided as soon as possible to discuss the role of surgery. Extensive rotator cuff tears may not be fixable, and transfer of alternative tendons or joint replacement may be possible.

ROTATOR CUFF ANATOMY

DISEASE EXPLAINED

SYMPTOMS

The pain associated with a rotator cuff injury may:

Be described as a dull ache deep in the shoulder

Disturb sleep

Make it difficult to comb your hair or reach behind your back

Be accompanied by arm weakness

CAUSES

Rotator cuff disease may be the result of either a substantial injury to the shoulder or to progressive degeneration or wear and tear of the tendon tissue. Repetitive overhead activity or heavy lifting over a prolonged period of time may irritate or damage the tendon.

The following factors may increase your risk of having a rotator cuff injury:

Age. As you get older, your risk of a rotator cuff injury increases. Rotator cuff tears are most common in people older than 60.

Construction jobs. Occupations such as carpentry or house painting require repetitive arm motions, often overhead, that can damage the rotator cuff over time.

Family history. There may be a genetic component involved with rotator cuff injuries as they appear to occur more commonly in certain families.

TREATMENT

TREATMENT OPTIONS

NON-SURGICAL OPTIONS
Conservative treatments — such as rest, ice and physical therapy — sometimes are all that's needed to recover from a rotator cuff injury. If your injury is severe, you might need surgery.

INJECTIONS
If conservative treatments haven't reduced your pain, your doctor might recommend a steroid injection into your shoulder joint, especially if the pain is interfering with your sleep, daily activities or physical therapy. While such shots are often temporarily helpful, they should be used judiciously, as they can contribute to weakening of the tendon and may lower the success of surgery if this is eventually needed.

THERAPY
Physical therapy is usually one of the first treatments your doctor may suggest. Exercises tailored to the specific location of your rotator cuff injury can help restore flexibility and strength to your shoulder. Physical therapy is also an important part of the recovery process after rotator cuff surgery.


SURGICAL OPTIONS
Many different types of surgeries are available for rotator cuff injuries, including:

Arthroscopic tendon repair. In this procedure, surgeons insert a tiny camera (arthroscope) and tools through small incisions to reattach the torn tendon to the bone.

OPEN TENDON REPAIR.
In some situations, an open tendon repair may be a better option. In these types of surgeries, your surgeon works through a larger incision to reattach the damaged tendon to the bone.

TENDON TRANSFER.
If the torn tendon is too damaged to be reattached to the arm bone, surgeons may decide to use a nearby tendon as a replacement.

SHOULDER REPLACEMENT.
Massive rotator cuff injuries may require shoulder replacement surgery. To improve the artificial joint's stability, an innovative procedure (reverse shoulder arthroplasty) installs the ball part of the artificial joint onto the shoulder blade and the socket part onto the arm bone.

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