Rotator Cuff Injury

What is the rotator cuff?

The shoulder joint is surrounded by four muscle-tendons, commonly referred to as the “rotator cuff.” These rotator cuff muscles (supraspinatus, infraspinatus, subscapularis, and teres minor) provide strength, stability, and support specific functions of the shoulder such as overhead motion.

Rotator cuff footprint. A, Lateral view of an intact rotator cuff with intervals marked before dissection. B, Model of the humeral head showing the articular surface (yellow) and insertional footprints of the supraspinatus (green) and infraspinatus (red). The subscapularis footprint (blue) is anterior to the biceps groove and the teres minor (black) is posterior-inferior.

 

How does a rotator cuff injury occur?

Rotator cuff injuries can occur from an acute injury (fall, trauma, traction injury), chronic overuse (sports, repetitive movement or lifting), or tendon degeneration (wear and tear). A rotator cuff injury occurs when any of the four muscle-tendon groups become damaged or injured. In severe cases, the tendon can be torn or separated from the shoulder joint (rotator cuff tear).

Superior (left) and posterior (right) projections of the rotator cable and crescent. The rotator cable extends from the biceps to the inferior margin of the infraspinatus (I) tendon, spanning the supraspinatus and infraspinatus tendon insertions. Mediolateral diameter of rotator crescent; biceps tendon; width of rotator cable; teres minor.

Classification of full-thickness rotator cuff tears by shape: crescent (A), reverse “L” (B), “L” (C), trapezoidal (D), and massive (E).

What are the symptoms of a rotator cuff injury?

Patients with rotator cuff injuries typically have pain and tenderness over the outside part of the arm, which may worsen at night. Pain can also worsen with carrying an object, simply lifting the affected arm, or lying on the shoulder. In many cases, patients will have persistent weakness keeping them from performing specific activities.

How is this diagnosed?

Dr. Zahab Ahsan and Sincer Jacob have extensive experience in diagnosing rotator cuff injuries. You can expect to have a physical examination that detects shoulder weakness, range of motion, deformities or signs of muscle wasting. Often multiple imaging techniques can also aid in the assessment including x-rays and a MRI. These diagnostic modalities help to assess the extent of the rotator cuff injury and ensure there are no other conditions that may be contributing to your symptoms.

What is the treatment?

Treatment of a rotator cuff injury is dependent on the severity of the injury. We think broadly in our approach (non-surgical vs. surgical).

Non-Surgical

Minor rotator cuff injuries do not require surgical treatment. A customized treatment plan will likely entail rest, ice and heat, anti-inflammatory medications, and a physical therapy program. The combination of these items leads to less pain and improved function. There may be a role for different types of injection therapy as well, including corticosteroid or platelet rich plasma (PRP).

Surgical

In cases which non-surgical treatment is not effective, or the rotator cuff repair is ideal a customized surgical approach may be recommended by Dr. Zahab Ahsan and Sincer Jacob. This decision is reached based on patient goals, and evidence-based practices. Dr. Zahab Ahsan commonly performs arthroscopy surgery to repair the rotator cuff. This minimally invasive method entails repairing the torn rotator cuff with the help of a small camera. The camera is inserted through a series of small incisions in the shoulder allowing for the damaged area to be viewed, and the tear to be repaired. Arthroscopic surgery is advantageous due to reduced pain and quicker return to sports and activity following surgery. Surgery results are most effective and successful when patients follow a rehabilitation protocol provided by our team.

If you have any questions regarding rotator cuff injuries please contact Dr. Zahab Ahsan or Sincer Jacob.

Series of images demonstrating arthroscopic rotator cuff repair construct with the aid of suture anchors.