The rotator cuff consists of muscles and tendons that keep the ball-and-socket joint between your arm and shoulder blade functioning correctly and help you lift and rotate your arm. There are four muscles in the rotator cuff — supraspinatus, infraspinatus, teres minor, and subscapularis. There is also a lubricating sac (called the bursa) between the rotator cuff and the acromion, or the bone on top of your shoulder
Tendinitis, Impingement, and Bursitis
Shoulder tendinitis occurs when the tendons are irritated or mildly damaged, and bursitis occurs when the bursa becomes inflamed or swollen. With shoulder impingement, the acromion rubs against the bursa or one of the tendons and causes pain or inflammation. Symptoms include pain or swelling in the front or outside part of the shoulder and pain when lifting or lowering your arm.
For many cases of tendinitis, impingement, or bursitis, the first course of treatment may be to rest the shoulder and use non-steroidal anti-inflammatory medications to reduce the inflammation in the shoulder. For some patients, physical therapy may also be recommended. In cases where pain and inflammation cannot be resolved through rest or physical therapy, surgery can help create more space for the rotator cuff by removing inflamed portions of the bursa, part of the acromion, or any bone spurs projecting downward off the acromion.
Rotator Cuff Tears
Another common source of shoulder pain is a rotator cuff tear. The majority of tears occur in the supraspinatus tendon, but a tear can occur in any or all of the four tendons. While this can be a painful injury for many people, it is also possible to have a rotator cuff tear with no symptoms of pain or dysfunction.
Symptoms include pain that occurs in relation to overhead activity or reaching out to the side, such as when putting on a coat or reaching for something above, beside, or behind you. However, pain may also be present when the shoulder is at rest, particularly if you are lying on the affected shoulder. Other symptoms include weakness when lifting or rotating your arm.
As people age, their risk for rotator cuff tears increase, with the average age of a symptomatic rotator cuff tear being 58 years old. Individuals whose jobs or hobbies involve a lot of overhead activity and those born with certain shapes of the acromion are most at risk for degenerative rotator cuff tears, or a wearing down of the tendon over time. Rotator cuff tears can occur in younger individuals as an acute tear caused by a specific injury or fall, but most rotator cuff tears are not the direct result of a specific trauma.
Treatment for rotator cuff tears may begin similarly to treatment for shoulder tendinitis or bursitis — with rest or activity modification to avoid painful movements or with physical therapy or other exercises to strengthen the muscles around the torn portion of the rotator cuff to compensate. Non-steroidal anti-inflammatory medications or a steroid injection may be prescribed to help reduce inflammation and pain.
One reason that rotator cuff injuries are common and don’t heal well on their own is that blood supply is limited. Blood supply, which is necessary for an area of the body to heal, comes through the bone to the tendons. If the tendon has torn to the point of detaching from the bone, then blood supply is even more limited, which makes it particularly difficult for complete tears to heal as opposed to partial tears.
While some rotator cuff tears can improve with nonsurgical treatment, many rotator cuff tears will ultimately require surgery. Most rotator cuff repairs are outpatient procedures, typically done arthroscopically using a camera and multiple small incisions about the size of the tip of a pen. A small number of more severe rotator cuff tears may require a latissimus dorsi or pectoralis major tendon transfer or a reverse shoulder replacement. On rare occasions, an arthroscopic debridement for pain control with or without biceps tenotomy (releasing the biceps tendon from the shoulder joint) may be performed if the tear cannot be repaired. This is typically reserved for patients who are not interested in or not candidates for larger procedures to resolve the problem.
If you are experiencing pain or limited movement in your shoulder, contact the Oklahoma Shoulder Center today for an appointment to determine the specific cause of your shoulder pain and discuss treatment options.