Treatment of Rotator Cuff Injuries
The most common shoulder injury for which adults require orthopaedic evaluation involves the rotator cuff. What exactly are “rotator cuff” injuries and what are the best interventions available for that diagnosis?
The rotator cuff encompasses four muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) which cover both sides of the scapula (shoulder blade) and connect it to the humeral head (the top of the humerus/arm bone). The cuff is the tendon, which is the attachment of these muscles to the humerus. It provides the dynamic stability required for complex shoulder movements. Basically, the cuff muscles maintain the concentric position of the humeral head (ball) in the glenoid of the scapula (socket) while larger muscles such as the deltoid, pectoralis major, and latissimus dorsi power the arm. If the cuff is torn or injured patients experience lateral arm pain and weakness on abduction (lifting the arm overhead) and external rotation of the arm at the side (pushing away from the body).
Treatment of rotator cuff injuries depends on the anatomy of the injury and level of patient dysfunction. Physical exam and MRI findings help delineate these factors. If the cuff is simply inflamed (tendonitis/bursitis aka impingement syndrome) or partially torn, conservative treatment is usually successful. Anti-inflammatory medication, judicious use of cortisone injections, and a rotator cuff stretching/strengthening program lead to resolution of symptoms up to 85% of the time in this scenario. If patients fail this treatment, shoulder arthroscopy (surgical procedure where a 4 mm camera and small instruments are inserted into the shoulder through small incisions) with bursectomy, removal of bone spurs, and debridement or repair of partial rotator cuff tears has a 90% success rate in terms of pain relief and improved function. If there is a complete rotator cuff tear, surgical repair is usually the best option in terms of functional restoration, although physical therapy can also improve function. If the time to repair is delayed too long, the tendon may become too scarred down to permit repair, so do not ignore it for too long. Rotator cuff repair can be done arthroscopically (minimally invasive) by repairing the torn tendon to bone using suture anchors (small screws that are inserted into the bone with embedded sutures that are used to sew the tendon to the bone). The success rate for this procedure in terms of pain relief and restoration of strength is approximately 90%, but total recovery may take 4-6 months.
The good news is that all of these injuries can be treated in a minimally-invasive fashion with a high rate of success if diagnosed in a timely fashion. If you have symptoms of a rotator cuff tear (pain and weakness, especially after injury) see your orthopaedic surgeon without delay.
Dr Robert S Wolf