| The term "rotor" cuff, actually- the rotator cuff- | | | | pain. Pain is most intense at night. The pain may |
| refers to a group of muscles and associated | | | | radiate down the side of the upper arm. This is |
| tendons that connect the scapula (shoulder blade) | | | | called referred pain. Rotator cuff problems are |
| to the humerus (upper arm bone). The rotator | | | | diagnosed by taking a careful history and doing a |
| cuff tendons sit on top of the humerus and | | | | thorough physical examination. Plain x-rays are of |
| permit movement in all directions. In fact, the | | | | limited usefulness unless the patient also has |
| shoulder is the most mobile joint in the body. | | | | concomitant arthritis. An MRI is probably the most |
| Because of the wide range of motion that the | | | | accurate method for imaging the entire shoulder |
| shoulder joint has... plus the amount of work that | | | | including the soft tissues, tendons, and bone. |
| the shoulder has to do doing activities of daily | | | | Diagnostic ultrasound is another less expensive |
| living, the rotator cuff becomes prone to overuse | | | | technology which is probably as effective for |
| and injury. Excessive stress on the rotator cuff | | | | visualizing the rotator cuff. Partial tears can be |
| leads to shoulder pain. Rotator cuff injury is fairly | | | | treated with anti-inflammatory medication and |
| common and can be due to repetitive stress, | | | | physical therapy. In patients with more severe |
| trauma, and aging. Repetitive stress can be | | | | pain or who do not respond to conservative |
| occupational- people who do work with the arms | | | | measures, injection of glucocorticoid (cortisone) |
| raised above the level of the shoulder- can | | | | can be effective. Injections should be done using |
| develop shoulder problems easily. Examples would | | | | ultrasound needle guidance. Otherwise, the |
| be auto mechanics, dry wall installers, house | | | | injection may not be done in the proper location. |
| painters, and electricians. Sports activities such as | | | | Larger rotator cuff tears generally don't heal |
| golf, tennis, softball, and other athletic endeavors | | | | without intervention. Depending on the age of the |
| that require repeated shoulder movement can | | | | patient, length of duration of the tear, size of the |
| also be a problem. Trauma, particularly falls are a | | | | tear, and the patient's other medical problems, |
| common cause of rotator cuff injury. As people | | | | surgery may be a solution. In cases where more |
| get older, the tendons that comprise the rotator | | | | conservative measures fail to provide relief from |
| cuff become more prone to injury and | | | | pain and improved function, surgery is also an |
| degeneration. The tendons of the rotator cuff are | | | | option. Most rotator cuff surgery is performed |
| made of tough fibrous connective tissue similar to | | | | arthroscopically using small incisions for the |
| connective tissue located elsewhere in the body. | | | | insertion of a tiny camera and surgical cutting |
| Examples of connective tissue include ligaments, | | | | instruments. As mentioned earlier, multiple factors |
| tendons, and cartilage. Connective tissue tends to | | | | go into deciding whether a patient is a good |
| degrade with age. Combining repetitive use with | | | | surgical candidate. Other factors determine |
| the aging process is a recipe for significant rotator | | | | prognosis. Factors that can influence healing include |
| cuff injury. Injuries to the rotator cuff usually are | | | | the size of the tear, the number of tendons that |
| due to inflammation. This is called tendonitis or | | | | are torn, smoking and patient age. Physical |
| tendonopathy. More serious injuries result in partial | | | | therapy following surgery is essential to restore |
| tearing of the tendons. Even more serious is a | | | | full mobility and to protect the surgical repair. This |
| "full-thickness" or complete tear. While there are | | | | may be arduous, taking several weeks before |
| many causes of rotator cuff injury, the most | | | | function is restored adequately. For prevention of |
| common is when the rotator cuff tendons are | | | | rotator cuff tears, it is good practice to consult a |
| squeezed between the humerus and the scapula. | | | | knowledgeable physical therapist who can teach |
| This squeezing occurs when the arm is raised | | | | specific exercises. Warming up and stretching |
| above the level of the shoulder. Symptoms of | | | | before activities is recommended. Patients should |
| rotator cuff related malfunction usually are pain | | | | avoid exercises that place the arm at extreme |
| related. Pain at night is very common and is | | | | positions, that involve lifting a large amount of |
| caused by inflammation in the both the tendons | | | | weight, or which involve repetitive motion |
| as well as the adjacent bursa. This bursa- called | | | | particularly with the arms higher than shoulder |
| the subacromial bursa- is a sack that contains a | | | | level. |
| small amount of fluid and cushions the shoulder. | | | | Nathan Wei, MD FACP FACR is a rheumatologist |
| When it becomes inflamed, the condition is called | | | | and Director of the Arthritis and Osteoporosis |
| bursitis. Muscle spasm may also contribute to the | | | | Center of Maryland. |