The Shoulder Rotator Cuff
     Rotator cuff injuries consist of a spectrum of issues ranging from bursitis/tendonitis to tears and arthritis. These usually start with pain in the shoulder often 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 issue are usually age related wear-and-tear that can start in your 40s, but can occur at any time especially 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. It can start as wear and tear in the supraspinatus tendon where it attaches to bone. 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 top or 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 with by modifying activities, taking over the counter medications, physical therapy, and sometimes a cortisone injection. Avoiding overhead lifting and certain sports can be helpful. It is important to see an orthopaedic physician as Xrays and a MRI can be helpful to confirm the diagnosis.

    Picture2    Picture4
 Hawkins impingement sign and subscapularis strength testing

Rotator Cuff Tears
     Rotator cuff tears are typically a later stage of impingement syndrome where there is tearing of the rotator cuff tendons from their bony attachment. Tearing 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 fairly rare in younger patients, usually only after significant trauma to the shoulder. Pain is similar to impingement syndrome, but can be associated with limitation of motion and has weakness. Other problems such as labral, SLAP, bicep tendon tears, and arthritis can also be present.
     Non-surgical treatment is similar to impingement with activity modification, avoiding overhead 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. Sometimes early surgical repair is the best option.

Arthroscopic Shoulder Surgery
     Recent advances in arthroscopic shoulder surgery mean that these problems can be treated on an outpatient basis with minimally invasive arthroscopy. This can result in reduced pain and earlier recovery, especially with range of motion. 
     Impingement syndrome is treated arthroscopically with a ‘subacromial decompression’. This involves an outpatient surgery using a few small skin incisions, through these the bursa is excised and any prominent bone spurs are removed, or ‘decompressed’. If there are no other problems in the shoulder this surgery has a very dependable result, with usually a 3 month recovery. Immediate motion and light use are the norm for most people, and physical therapy can help the recovery process.
     Rotator cuff repairs are more involved, and these are also treated arthroscopically with outpatient surgery. Several small incisions are used and the rotator cuff is reattached to bone. Arthroscopic repairs used to be advanced treatment, but are now fairly routine.

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

For appointments call  925-939-8585
Monday through Friday
8am to 5pm
 

 
  Site Map