The shoulder is a “ball and socket” joint which is held in place by the rotator cuff – a group of four small muscles and tendons (connecting muscle and bone) that envelop the joint. The rotator cuff stabilizes the shoulder joint while enabling the arm to move around in space. While the shoulder is the joint with the greatest range of motion, it is also the least stable, and injuries to the rotator cuff are not uncommon. Problems with the rotator cuff occur over a large spectrum:
On the mild end of this spectrum is inflammation in the space directly above the rotator cuff (often referred to as bursitis). This usually manifests itself as pain in the shoulder or upper arm that may become worse after activity.
If the inflammation progresses to involve the rotator cuff tendon, tendonitis is in play. Tendonitis can produce increased pain in the shoulder that tends to worsen during activities such as overhead work, throwing a ball or other arm movement away from the body.
Untreated inflammation can progress to degeneration (breakdown) of the tendon, or tendinosis. When rotator cuff disease progresses to this point, the pain is usually more noticeable and patients begin to experience more persistent pain with activity. This “partial thickness tearing” of the rotator cuff means the connection between the tendon and bone begins to peel away, with less tendon attached to the bone.
Rotator Cuff Tear
A full-thickness tear occurs when there is a complete separation of a section of the rotator cuff from the arm bone (humerus). At this point, patients will begin to notice definite weakness with lifting or other shoulder activities. If ignored, these tears can progress and become very large over time. It is possible that an untreated tear can even become large enough that traditional surgical repair is no longer an option.
The early stages of rotator cuff disease – bursitis, tendonitis, and minor tendinosis – can usually be treated successfully with nonsurgical options including: rest, activity modification, icing the shoulder, physical therapy and possible anti-inflammatory injections (as deemed appropriate by your physician). Unfortunately, once full-thickness tears occur, these conservative treatment options will not allow for a reversal of damage. Although some patients may be able to relieve their pain and restore their normal range of motion through nonsurgical care attempts, those patients cannot expect a full return of strength in the shoulder without surgical treatment.
Currently most rotator cuff surgeries are performed arthroscopically – in which a small camera is used through multiple small, poke-hole incisions around the shoulder (rather than a large, open incision). This method generally results in accelerated recoveries and less pain, as compared with open surgical procedures. Following surgery, excellent outcomes can be expected for most rotator cuff tears, with the great majority of patients being able to return to their chosen level of activity after the necessary recovery period.
If your shoulder is bothering you and it has not improved with rest, talk to the shoulder specialists at Great Lakes Orthopaedic Center about how we can help relieve the pain, and return you and your shoulder to your favorite activities.