The Rotator Cuff
The rotator cuff is a group of four muscle-tendon units that originate from the shoulder blade and attach to the humeral head of the shoulder. These four muscle-tendon units (supraspinatus, infraspinatus, subscapularis and teres minor) are important in maintaining dynamic stability of the shoulder joint and to provide movement of the upper extremity away from the body such as reaching forward, backward or above shoulder level.
The supraspinatus is the most common component of the rotator cuff involved with pathology. These pathologies are one of the most common causes of shoulder pain. The pain is often felt as sharp or deep and achy, is usually located over the front corner of the shoulder and may radiate down towards the elbow. These pains are often experienced when getting dressed, reaching to the backside, reaching above shoulder level or when lying on the side. While there may be trauma associated with the onset of rotator cuff symptoms they more commonly manifest insidiously with a gradual onset. Rotator cuff pain can occur from simple inflammation of the tendon (often called tendinitis or bursitis), partial tearing or full-thickness tearing. It is often difficult clinically to separate pain generated by tendinitis from that which occurs from a complete tear. Associated symptoms may be feelings of weakness and stiffness or loss of motion. Symptoms from tendinitis often begin to present themselves in patients age 20 and beyond, rotator cuff tears generally do not occur prior to the age of 40.
Evaluation and Treatment
Physician evaluations for shoulder pain generally include a thorough history and physical examination of the shoulders and upper extremities, along with x-rays of the symptomatic shoulder. Initial treatment options include activity modification, cortisone injection, oral anti-inflammatories, and/or physical therapy. Patients who fail to improve with initial treatment modalities may be recommended to undergo an MRI examination to more fully evaluate the rotator cuff. Regular x-rays do not visualize the soft tissues of the rotator cuff, and thus an MRI can be very helpful in separating out tendinitis from rotator cuff tears in those individuals who do not improve with initial treatment.
Patients who are found to have painful rotator cuff tears have the option to undergo surgical treatment. I perform rotator cuff surgery utilizing minimally invasive techniques of arthroscopy. Surgeries are performed on an outpatient basis. Outpatient therapy is employed postop to maximize recovery and rehabilitation. Our goal is to minimize pain and maximize functional outcome.
Other conditions which can cause shoulder pain include but are not exclusively those of impingement, osteoarthritis, frozen shoulder, labral tears and biceps tendinopathy. These conditions will be addressed in future blogs, so please stay tuned.