Photo: Dr. W. Sol Graves, MD

By White "Sol" Graves, M.D.

The shoulder is an extremely fascinating and complex joint. It’s shallow socket and round ball allows us to reach and use our hands in many different positions. However, this increased range of motion and activity make the shoulder joint less stable and more prone to injury.

The rotator cuff tendons play a key role in the normal healthy function of the shoulder. The rotator cuff is formed by the tendons of 4 muscles: the supraspinatus, infraspinatus, teres minor, and subscapularis. The rotator cuff connects the ball part of the shoulder (the humerus) to the shoulder blade and socket (the scapula).

The rotator cuff tendons have areas of very low blood supply, and these areas make the tendons especially vulnerable to degeneration from aging. These degenerative changes help explain why the rotator cuff is more commonly injured later in life.

Unfortunately, with degeneration rotator cuff injuries can occur even with everyday activities. However, repetitive activities (especially overhead) tend to lead to the most problems with the rotator cuff.

Many tears to the rotator cuff occur with excessive force, such as trying to catch a heavy object or lifting a heavy object with the arm extended. In addition a fall directly on the shoulder can lead to tears of the rotator cuff.

Rotator cuff tears typically cause pain and weakness in the shoulder. In some cases tears may be partial and cause pain but still allow good motion and strength.

Most complete tears will result in weakness and pain, and very large tears can sometimes limit the ability to raise the arm away from your side.

Rotator cuff injury is best diagnosed with a history, physical exam, plan X-ray and in most cases an MRI. MRI is extremely useful in determining if a tear is present, as well as where the tear is located and the size of the tear.

A complete rotator cuff tear will not heal. Complete tears usually require surgery if your goal is to return your shoulder to optimal function. Partial tears may not require surgery. Non-operative treatment options include rest, anti-inflammatory medicine, steroid injections, and physical therapy. However, if pain and dysfunction persist, then surgery may be needed.  

If surgery is needed to repair the rotator cuff, excellent results can usually be obtained through an arthroscopic repair. This is an outpatient procedure that only requires small stab incisions. The arthroscope allows excellent visualization of the rotator cuff and a thorough evaluation of the entire shoulder joint. The repair is done by placing small anchors in the bone (humerus). Stitches from the anchor are passed through the rotator cuff tendon and securely tied, repairing the tendon back to the bone.

If you are living with shoulder pain or suspect you have a rotator cuff tear, consider scheduling an appointment with one of our orthopaedic surgeons who can properly diagnose and treat your condition.