SOMA Orthopedics
Medical Group Inc.
When
Conservative Treatments Can’t Do the Trick
Like the hip, the shoulder is a
ball-and-socket joint. The socket of the shoulder,
however, is much shallower. This allows a greater
range of motion for the shoulder, but it presents
problems with stability. The “rotator
cuff” consists of four tendons that attach
the shoulder muscles to the upper arm. The rotator
cuff helps maintain the stability of the shoulder
while lifting the arm overhead and rotating the arm
from side to side.
What are the
rotator cuff injuries?
Rotator
cuff injuries can result from traumatic injuries,
muscle atrophy or repetitive overuse. The problem
may be “bursitis,” in which the bursa
(a sac of lubricating fluid located between the
upper arm and part of the shoulder blade) is
squeezed, becoming irritated or inflamed. Another
possibility is “tendonitis,” a chronic
inflammation of the tendons usually caused by
overuse.
“Impingement” -- pinching of the
tendons – can occur as the rotator cuff rubs
under part of the shoulder blade when the arm is
lifted overhead. A rotator cuff “tear”
occurs when the tendon separates from the bone.
Most rotator cuff tears result gradually over time
from impingement, but some tears happen suddenly.
Regardless of the cause, people with rotator cuff
problems typically experience symptoms such as pain
when reaching for an object or lifting something
overhead, the inability to lift the arm to the
side, or pain at night while sleeping.
Which rotator
cuff injuries may benefit from surgery?
Most
rotator cuff injuries improve with prolonged
physical therapy. Physicians also may advise
non-steroidal anti-inflammatory drugs (NSAIDs) or
steroid injections to decrease inflammation and
pain. Any of the above rotator cuff problems may
potentially benefit from surgery, however, and
surgery is often required to repair a rotator cuff
tear.
Various procedures are used, all beginning with a
diagnostic arthroscopic evaluation. Some problems
may require only arthroscopic
“debridement,” removing loose fragments
of tendon, thickened bursa and other debris from
the shoulder. Other injuries require more extensive
repair. Almost all rotator cuff surgery involves
removing the bursa and shaving the underside of the
shoulder blade to prevent further impingement.
Rotator cuff repair can be performed either
arthroscopically or with a minimally invasive
incision.
More than 90 percent of patients will have
significantly less pain and improved function after
rotator cuff surgery. Most patients are able to go
home the same day with oral pain medication. For
optimal results, the patient should participate in
an extensive physical therapy program.