January 2009

Rotator Cuff Tears

Normal MRI

MRI of Rotator Cuff Tear

Shoulder complaints occur in approximately. 7%-2% of the population each year with an even greater percentage of athletes. A rotator cuff tear is among the more serious shoulder pathologies. The rotator cuff complex is a group of 4 muscles along with their tendinous insertions on the proximal humerus (upper arm). They include the supraspinatus, infraspinatus, subscapularis and teres minor. These muscles work together to provide functional stability which allows for the full range of motion that is available in the shoulder joint. Injury to one or more of these tendons can reduce the stability of the shoulder lleading to pain, weakness and limited motion. A rotator cuff tear may occur spontaneously, after a sudden movement or after a traumatic event. Symptoms may include pain in the shoulder, weakness, and an inability to raise the arm out to the side or over head. Tears most often occur in individuals greater than 40 years of age. Common causes include age, disuse, steroid injections, impingement or major trauma.

A diagnosis of rotator cuff tear is based on signs and symptoms which include loss of active motion, muscle wasting over the scapula (shoulder blade), weakness and night pain. Diagnostic tests may include an x-ray demonstrating a high riding humerus, an arthrogram (x-ray with dye) or an MRI which would show the size and degree of the tear.

Rotator cuff tears may be managed conservatively or may require surgical repair. Conservative treatment may include but is not limited to anti-inflammatory drugs, cortisone injections, heat, ice, rest and rehabilitation programs. A rehab program will focus on decreasing pain, restoration of normal motion, then strengthening of the shoulder musculature first at the side of the body and then gradually progressing to strengthening overhead without aggravating symptoms. Postural alignment and patient compliance with the program are critical to its success. Approximately 50% of patients with rotator cuff tears improve to their satisfaction within 4-6 months after starting rehab. For those who do not progress or continue to have pain even after regaining strength, surgical intervention may be warranted.

If you have injured your shoulder or simply have questions regarding shoulder pain, we have qualified professionals at each of our facilities that would be able to answer any questions and provide a comprehensive evaluation and rehabilitation program specific to your condition.