With the greatest range of motion than any other joint in the body, the shoulder is vulnerable to injury as well as many problems that can cause pain, tenderness and weakness. The shoulder is surrounded by four muscles (the infraspinatus, teres minor, supraspinatus, and subscapularis) and accompanying tendons, which are collectively called the Rotator Cuff and serve as part of a delicate balance of strength, flexibility and stability.
Rotator Cuff tears can result from a single action or the cumulative affect of gradual degenerative stress caused by long term involvement in overhead sports such as throwing, tennis and swimming – possibly following rotator cuff tendonitis, impingement, or dysfunction. Tears can also result from the degenerative affects of aging. Damage is classified as either extrinsic (initiated from the outside and resultant of a trauma or overuse), or intrinsic (initiated from the inside and resultant of degeneration with aging and calcific presence).
Symptoms generally include pain, weakness and loss of motion. Pain intensifies during overhead or above the shoulder activities. There may also be night pain that disrupts sleep.
Those at Risk
Athletes involved in overhead sports and the elderly experiencing tissue degeneration in the shoulder joint are most often diagnosed with a rotator cuff tear. Though, calcific tendonitis, which can eventually lead to a rotator cuff tear, may occur in those ranging in age from 30 to 50 years.
Patient history and physical examination is key in establishing any diagnosis, but particularly for a rotator cuff tear. Pain is assessed as patients move through a series of passive shoulder movements involving forward flexion, as well as internal and external rotation at various rotations.
Radiographic testing is also helpful in eliminating the presence of calcific deposits and other contributing factors. In patients with a history of severe trauma or who experience extreme weakness, magnetic resonance imaging or an arthrogram may be indicated in order to determine appropriate treatment.
Most rotator cuff injuries can be addressed nonsurgically and may respond to a course of conservative treatment that includes anti-inflammatory medication and rehabilitative exercises – involving all muscle groups instrumental in shoulder function, with both positive and negative force. If pain persists, cortisone injection treatment may be indicated.
And in more serious cases non responsive to conservative treatment, arthroscopic surgery may be indicated and instrumental in removing damaged portions of the bursa and repairing the torn rotator cuff tendons with suture anchors. Arthritis of the AC joint and other shoulder pathology can also be addressed at the same time.