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 The Shoulder Rotator Cuff
     Rotator cuff injuries consist of a spectrum of issues ranging from bursitis and tendonitis, to tears and arthritis. These usually start with pain in the shoulder often are related to a minor injury or a certain activity. It is very common for the pain to occur while sleeping at night, and it can be hard to sleep on the shoulder. Rotator cuff issues commonly are age related and can start in your 40s, but can occur at any time if related to an injury or sports. 

Impingement Syndrome
     Impingement syndrome refers to tendonitis in the rotator cuff tendons in the shoulder. Impingement was 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 wear. Pain is usually on the outside of the shoulder and hurts while sleeping, although symptoms can 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, using over the counter medications, physical therapy, and sometimes a cortisone injection. Avoiding overhead lifting and certain activities can be helpful. It is important to see an orthopaedic surgeon, as Xrays and a MRI can be helpful to confirm the diagnosis.

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 Hawkins impingement sign and subscapularis strength testing

Rotator Cuff Tears
     Rotator cuff tears can be a later stage 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 event. It is rare in younger patients, usually after trauma to the shoulder. Pain can be similar to impingement syndrome, but can be associated with more 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. These treatments are more appropriate for partial rotator cuff tears, as painful full tears will usually not respond well to non-operative treatment. It is important that you are examined by an orthopaedic specialist, as Xrays and MRI can confirm a tear. Many times early surgical repair is the best option.

Arthroscopic Shoulder Surgery
     Advances in arthroscopic surgery help these problems to be treated with outpatient surgery using minimally invasive techniques. This can result in reduced pain and earlier recovery. 
     Impingement syndrome is treated arthroscopically with a ‘subacromial decompression’. This involves an outpatient surgery using a few small skin incisions, and the bursa is excised along with any prominent bone spurs. Motion and light use are started early, and physical therapy can help the recovery process.
     Rotator cuff repairs are more involved, but these are also treated arthroscopically with outpatient surgery. Small incisions are  made and the rotator cuff is reattached to bone arthroscopically. The recovery process involves a step-wise program supervised by a physical therapist and usually lasts 6 months.

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

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