Rotator cuff disease is the vulnerable environment created within the shoulder joint by a history of shoulder overuse or repetitive stress conditions – including rotator cuff tendonitis, subacromial bursitis, impingement syndrome, and general dysfunction involving partial or complete tearing of the rotator cuff tendons.
It is a disorder of the musculotendinous cuff surrounding the glenohumeral joint and is a continuum of pathology involving a range of rotator cuff conditions leading to degenerative shoulder stability. Symptoms usually include a dull ache at the upper outer arm and shoulder during activity, with overhead activities becoming increasingly difficult. Pain in the shoulder may extend down to the elbow, and neck pain on the same side may also develop later as scapular elevators are excessively used to compensate for abnormal glenohumeral motion.
In early stages, patients may also experience snapping within the shoulder and night pain and discomfort. Later, weakness and loss of shoulder motion become increasingly evident.
Those at Risk
Rotator cuff disease in large part is a condition related to age and the affects of lifelong wear and tear. It most frequently affects athletes involved in forceful overhead or throwing sports, as well as laborers frequently using hammers and jackhammers.
The type of related conditions experienced depends on the age of the patient and stage of the disease. While any single condition related to rotator cuff disease or a single tear resulting from a trauma can occur at any age, there is a general pattern in determining the various stages of rotator cuff disease. Patients in their 40s are most often affected by inflammatory conditions such as bursitis and rotator cuff tendonitis. Patients in their 50s may be diagnosed more frequently with tendinosis, or degeneration. And patients in their 60s often experience tears in response to the weakened environment and joint degeneration.
A thorough patient history and physical examination will most likely confirm suspicions. A special X-ray (arthrogram), or magnetic resonance imaging (MRI) may be indicated for patients with a history of shoulder pain in order to verify the condition of the rotator cuff muscles and shoulder joint.
Conservative nonsurgical treatment is effective in addressing many of the symptoms associated with rotator cuff disease. These may include; cold compression to reduce swelling, nonsteroidal anti-inflammatory drugs (NSAIDs), a period of rest and refrain from activity that aggravates the condition, and a rehabilitative exercise program designed to strengthen shoulder muscles and improve range of motion.
Injection therapy including lidocaine and corticosteroid may be recommended when pain persists despite initial conservative treatment, or if lesions are present but surgery is not advised for a particular patient. This is determined based on the age, condition and activity level of each patient.
When conservative treatment does not improve the condition after a six-month period, arthroscopic surgery may be indicated in order to facilitate decompression. Debridement may be indicated for frayed or partially torn tendons.
For more serious tears, exploratory arthroscopy and surgery may be indicated in order to reattach the tendon to the bone. Rehabilitative strengthening and range of motion exercises begin shortly thereafter.