The shoulder is a very complex joint due to its very extensive range of motion. Unlike other joints, the shoulder is very mobile, with motion in front of the body, behind the body and above the head.
The shoulder’s mobility comes from the way the bones, the humerus and the glenoid, come together, and the muscle which helps the shoulder move.
The muscles around the shoulder are many and include the chest muscles, the pectoralis major and minor; the deltoid; the arm muscles such as the biceps and the triceps, and, most importantly the rotator cuff.
The rotator cuff is a group of muscles that start from the scapula, or the shoulder blade, and attach to the head of the humerus to help move the shoulder.
These muscle are called the rotator cuff since their combined effort is to help to rotate the shoulder. The rotator cuff is made up of four muscles: the supraspinatus, the infraspinatus, the teres minor and the subscapularis. Together, as these muscle attach to the head of the humerus, they form a cap-like structure — a cuff — over the top of the humerus.
The role of the rotator cuff is to help stabilize and rotate the humerus as the shoulder moves. As a result, these muscles are always in use whenever we use our arms, and especially so when we use our arms above our heads.
As we age, or due to trauma (from a fall or sporting activities, especially throwing sports) the rotator cuff can become damaged, leading to pain and/or weakness. This damage can often happen at the junction of the rotator cuff tendons as they attach to the humerus.
Patients who develop rotator cuff tendinitis often complain of shoulder pain, especially with movement above the head and even pain at rest or sleeping on that shoulder at night. Weakness can also be present with activities.
Initial treatment is often rest, anti-inflammatory medication and physiotherapy, which can be very effective in decreasing and managing symptoms. These measures are often tried for a period of time — say a month — to see if they work.
If symptoms persist, the next line of treatment includes other diagnostic studies such as an MRI scan to see the condition of the rotator cuff and its tendons. If there is no tear in the tendon then the initial treatment can continue with the addition of a steroid injection to help decrease the inflammation.
Most patients with an initial episode of rotator cuff tendinitis will respond well to this initial treatment of rest, medications and physiotherapy.
Patients with chronic rotator cuff tendinitis, or a rotator cuff tear, might require more advance treatment such as arthroscopic surgery. With this type of surgery, special instruments are placed within the space above and below the rotator cuff and the damaged tissue removed and the rotator cuff repaired as necessary.
Sometimes, the rotator cuff tear is too large to be repaired. In these circumstance, the damaged tissue is removed, and at times this is enough to relieve the patient’s pain. Following surgery, physiotherapy is reinstituted based on the extent of the surgery and the surgical repair.
Patients with rotator cuff tendinitis or a rotator cuff tear will often have a successful outcome with a decrease in their pain and a restoration of function after the proper treatment is instituted.
Dr. Dwight S. Tyndall, FAAOS, is a minimally invasive spine surgeon practicing in the Region at DrSpine.com. His column, which appears every other week, covers a wide range of health and medical issues.