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 The Rotator Cuff
     Rotator cuff injuries are a spectrum ranging from bursitis/tendonitis to tears and arthritis. These usually start with pain in the shoulder sometimes related to a minor injury or overhead activity. It is very common for the pain to occur while sleeping at night and it can be painful to sleep on the shoulder. Rotator cuff issues often are age related and can start in your 40s, and increase with age.

Impingement Syndrome
     Impingement syndrome is tendonitis in the rotator cuff in the shoulder. This was commonly referred to as bursitis in the past. Often there is a bone spur on the acromion that can ‘impinge’ on the rotator cuff, causing inflammation and fraying. Pain is usually on the front/outside of the shoulder and hurts while sleeping, although symptoms vary. Often it is painful to reach overhead and behind the back, and weakness and stiffness can occur. Impingement is treated initially by modifying activities, over the counter medications, physical therapy, and usually a cortisone injection. Avoiding overhead lifting and certain activities can be helpful. It is important to see an orthopedic surgeon as xrays and possibly a MRI can be helpful to confirm the diagnosis.

Rotator Cuff Tears
     Rotator cuff tears can be from progression of impingement syndrome, where the rotator cuff tendons tear from their attachment. This usually starts with the supraspinatus and can progress to the infraspinatus or other tendons. Usually this happens over time, but can occur as a single traumatic event. Pain can be similar to impingement syndrome, and can be associated with weakness. Other problems such as labral, SLAP, bicep tendon tears, and arthritis can be present.
     Non-surgical treatment is similar to impingement with activity modification, avoiding heavy lifting, over the counter medications, and physical therapy. It is important to be examined by an orthopaedic specialist, as xrays and MRI are needed to confirm the diagnosis. Often surgical repair is the appropriate option.

Arthroscopic Shoulder Surgery
     Advances in arthroscopic surgery have moved these surgeries from the hospital to outpatient centers. Impingement syndrome is treated arthroscopically with a ‘subacromial decompression’. This involves an outpatient surgery using a few small  incisions, and the impinging bone spur and bursa are removed.
      Rotator cuff repairs are more involved, and these are also treated arthroscopically in an outpatient setting. A few small incisions are made and the rotator cuff is reattached. The recovery process involves use of a sling for 6 weeks, and a program supervised by a physical therapist usually lasting approximately 4 months.

     tear  repair
      Arthroscopic view of rotator cuff tear before and after repair



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