The rotator cuff consists of four muscles that surround the
ball and socket joint in the shoulder. Their
role is to initiate shoulder
movement and to stabilize the joint by compressing the ball against the socket
when larger muscles such as the deltoid, trapezius, and latissimus are
recruited to perform heavy lifting or overhead activities such as those in
tennis or baseball. Overuse and acute traumatic injuries can cause a tear in
one or more of the tendons that attach the rotator cuff muscles to the bone on
the ball of the shoulder. This is a common injury seen in orthopedic sports
medicine clinics. The patient that presents with a rotator cuff tear typically
will describe pain or inability to use their arm
away from their body. This
includes reaching overhead, reaching away from their body and reaching behind
the back. Physical examination will often demonstrate weakness in muscle
testing of the rotator cuff. X-rays are most often normal. An MRI or an ultrasound test can be used to determine if a rotator cuff tear is present.
Depending on the individual surgery or nonoperative
management may be an option. Chronic tears with a gradual onset can frequently
be managed by physical therapy as we demonstrated in our MOON Shoulder study
where 85% of patients over 50 years old with chronic tears were successfully
managed for a minimum of a year without surgery. Future blogs will discuss this study further, but it can be found here. MOON Shoulder Study It appears that surgery is more routinely indicated in a couple of
circumstances: 1.) tears in individuals less than 50 years old and 2.) acute
tears with no previous history of a full thickness tear. This is somewhat
controversial and strict indications for rotator cuff repair are difficult to
tease out of the medical literature as Brian Wolf, Warren Dunn and I found when
we performed a review on the topic in the American Journal of Sports medicine. Rotator Cuff Repair Indications
Surgical repair involves typically an arthroscopic approach
utilizing small puncture wounds where small minimally invasive instruments are
used to reattach the torn rotator cuff tendon. This is done by placing anchors
with sutures into the bone and stitching the tendon in place. Physical Therapy
begins shortly after surgery and continues 3-4 months until strength and motion
have been regained.
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