SOMA Orthopedics

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.