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What is the rotator cuff and rotator cuff pathology?

The rotator cuff is a group of four muscles and tendons that surround the shoulder joint, providing strength and stability. Above the rotator cuff there is a bursa, or sac of tissue, that covers and protects the rotator cuff as it comes into close contact with bones around the shoulder. When the rotator cuff is injured or damaged it can lead to inflammation of the bursa (bursitis), causing pain and loss of motion. Thickening of the rotator cuff and its bursa can lead to an impingement syndrome where the tissues impinge against the bones around the shoulder. This can cause pain and further damage to the rotator cuff.

While some rotator cuff injuries occur in younger people secondary to trauma, most injuries result from aging and degeneration of the cuff tissues. Damage to the rotator cuff can vary from microscopic tears to large irreparable tears. The symptoms of rotator cuff tears include pain, weakness, restricted motion, catching, locking and a feeling of instability. Rotator cuff pathology ranges from a normal, asymptomatic aging process to endstage arthritis and instability caused by the absence of the rotator cuff.

Who gets it?

Rotator cuff tears increase in incidence with age; however, not all rotator cuff tears are painful, and many individuals with rotator cuff pathology are completely asymptomatic. When it does become symptomatic, it can present in a variety of ways, ranging from minor problems to severe pain and limitation of function. Onset of symptoms can be related to ordinary activities of daily living, or they can be attributed to a single event. The symptoms are usually

aggravated in certain positions, such as reaching the back, for example, to fasten a seat belt or picking up a briefcase out of the back seat. Symptoms are worse when the arm is elevated overhead, especially if the elevated

arm is loaded, such as picking up a stack of plates out of a cupboard. Overhead activities (pitching, throwing, tennis, or racquetball) commonly worsen symptoms.

How is rotator cuff pathology diagnosed?

History and physical examination are the best way to initially evaluate rotator cuff pathology. It is important for the doctor to differentiate shoulder pain that may not be coming from places other than the shoulder, such as from the neck or even the heart. On the exam, pain can be provoked by overhead maneuvers, and there may be weakness of the shoulder muscles. Although plain X-rays do not show the rotator cuff muscles, they are helpful to look for calcifications, arthritis, or bone problems such as spurs that can cause rotator cuff tears. MRI is the most utilized imaging method to diagnose rotator cuff tears. Exams can be used to look for tears, inflammation of tissues and to help determine the size and quality of the tear, which helps direct proper treatment. Injections and even arthroscopy may be used to diagnose rotator cuff tears.

What are the rotator cuff treatment options?

Alterations in activities and learning to use the shoulder in a safer, more comfortable manner are important. Physical therapy may help improve mobility and strengthen shoulder muscles. Anti-inflammatory medications and injections are used for pain relief and to decrease inflammation. If these treatments fail, then surgical intervention is a reasonable option. Arthroscopy is most often the surgical treatment of choice to remove inflamed bursa and impinging bone spurs. The end of the clavicle (collarbone) may be removed if it has impinging spurs. Often rotator cuff tears can be repaired with arthroscopic techniques. Other tears require a larger incision and surgical exposure. Some large tears, particularly those associated with resultant arthritis, simply cannot be repaired and require major surgical options such as joint replacement surgery.

Rotator Cuff Rehabilitation

Postoperative treatment depends on the operation done, but therapy is a critical part of the recovery, which can take from three to twelve months. A coordinated effort between the patient, surgeon, and physical or occupational therapist is required.

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