Rotator Cuff Tears
The rotator cuff is a series of four muscles that originate from the shoulder blade and attach to the outside portion of the shoulder. When the rotator cuff is torn, patients often have difficulty raising the arm above their head. The function of the rotator cuff, however, is not raise the arm, but to stabilize the ball in the shoulder socket. With the ball stable the larger muscles around the shoulder, such as the deltoid, are then able to help raise the arm.
Injuries to the rotator cuff can lead to rotator cuff tendinosis, partial thickness tears and full thickness tears. There is significant debate about the cause of rotator cuff injuries. Some believe that injuries are caused by trauma that occurs over time from excessive use of the arm. The second belief is that injuries are secondary to degeneration that occurs over time and unrelated to a patients activity level of use of the arm. There is significant evidence supporting both beliefs and it is my medical opinion that both trauma and natural age related degeneration are responsible for rotator cuff problems.
Typically, rotator cuff tendinosis and partial thickness tears are treated by non-operative means. Physical therapy, ice, anti-inflammatories, and steroid injections are all treatment options. Most patients will improve with these therapies. For those that remain symptomatic, shoulder arthroscopy may be necessary.
Full thickness rotator cuff tears are treated with rotatory cuff repair. Recent research has shown that small rotators cuff tears become larger with time. The larger the tear, the more the tendon retracts away from the bone. When the tendon retracts, the muscle begins to atrophy and undergoes irreversible changes. After these changes occur, function of the rotator cuff cannot be restored with traditional repair. Patients suffer from significant pain and disability.