VIDEO: Rotator Cuff Tendonitis
VIDEO: Shoulder Arthritis and Replacement
About Shoulder Pain/Rotator Cuff
Receive effective treatment for your shoulder pain in the physical therapy clinic at the University Orthopaedic Center. Specialists at the clinic carefully examine injuries and create individualized treatments for your particular condition. The team of specialists at the clinic also not only treat patients but participate in cutting-edge research, which helps them provide the most up-to-date treatment options.
Rotator Cuff Injury
What is rotator cuff injury?
The rotator cuff consists of muscles and tendons that hold the shoulder in place. It is one of the most important parts of the shoulder. The rotator cuff allows a person to lift his or her arms and reach up. An injury to the rotator cuff, such as a tear, may happen suddenly when falling on an outstretched hand or develop over time due to repetitive activities. Rotator cuff tears are also due to aging.
What are the symptoms of a rotator cuff tear?
The following are the most common symptoms of a rotator cuff tear. However, each individual may experience symptoms differently. Symptoms may include:
Recurrent pain, especially with certain activities and at night
Pain that prevents sleeping on the injured side
Grating or cracking sounds when moving the arm
Limited ability to move arm
The symptoms of a rotator cuff tear may resemble other conditions or medical problems. Always consult your doctor for a diagnosis.
How is a rotator cuff injury diagnosed?
In addition to a complete medical history and physical examination, diagnostic procedures for a rotator cuff injury may include the following:
X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
A rotator cuff may tear partially or fully. Partial-thickness tears do not completely sever the tendon from the shoulder.
Treatment for a rotator cuff injury
Specific treatment for a rotator cuff injury will be determined by your doctor based on:
Your age, overall health, and medical history
Extent and duration of the condition
Your tolerance for specific medications, procedures, or therapies
Expectations for the course of the condition
Your opinion or preference
Treatment may include:
Nonsteroidal anti-inflammatory medications
Strengthening and stretching exercises
Surgery (for severe injuries)
Frequently Asked Questions About Rotator Cuff Arthropathy
- What is rotator cuff arthropathy?
- How is the diagnosis made?
- What non-surgical treatment is there?
- Is there more than one surgical option?
- When is surgery recommended?
- How is the procedure done?
- How does the anesthesia work?
- What are the possible complications?
- What about therapy and return to my normal activities?
- What are the limitations of my shoulder after surgery?
Rotator cuff arthopathy is when a patient has a large rotator cuff tear and poor rotator cuff function meaning that the shoulder is not centered in the socket. Because of this the shoulder does not have adequate elevation or motion. Over time the shoulder gets arthritic and rubs abnormally, not only on the socket but also up on the tip or acromion of the shoulder. Overall, patients have very poor range of motion and an inability to lift their arm along with constant pain.
The diagnosis of rotator cuff disease is made by taking a history from the patient, doing a physical examination and an x-ray. Occasionally an MRI is used to augment the information on the status of the rotator cuff problem.
Non-steroidal anti-inflammatory medications such as Ibuprofen can help some discomfort, but obviously will not help shoulder strength and motion. It is difficult to improve this situation through exercise since the muscles are not attached to the shoulder normally. Occasionally cortisone injections give some temporary relief and are an option for some individuals.
A new procedure has become available in the United States called a reverse shoulder replacement. It is called a reverse replacement because there is a metal ball that is actually screwed into the socket side of the shoulder and a plastic cup that is placed on the top of the humeral arm bone reversing the regular arrangement. The metal and plastic helps with eliminating pain, and the shoulder can now function better using just the deltoid muscle to help move it. Significant motion gains are possible after this procedure for many patients whereas in the past these were not seen with other procedures.
Surgery is recommended for patients who do not have significant rotator cuff function and have a normal deltoid muscle. Patients need to be older—usually at least 65 years of age. The procedure offers the most to the patient who has very minimal ability to elevate or lift his or her arm and also has significant pain; also the patient should not have the option for rotator cuff repair.
The procedure involves removing the top of the humeral bone and replacing this with a plastic cup that sits on a metal stem, which is placed down into the humerus or arm bone. A smooth metal hemisphere is then screwed onto the glenoid. The cup on the humerus is snapped into position under this metal ball and held in place by tension applied from the intact muscles. This allows the shoulder to have the deltoid muscle re-tensioned, which allows it to work more efficiently in the absence of the rotator cuff muscles. This procedure takes approximately two hours and the standard time in the hospital is one to two days.
One of the truly unique features of shoulder arthroplasty at the University of Utah Orthopaedic Center is the use of a small catheter that is placed near the nerves in the neck (anesthesia). We have a unique system for placing these with a high level of accuracy and minimal discomfort for the patient. This catheter allows anesthesia to run into the area slowly over a couple of days. Because of this it is very common for arthroplasty patients to have minimal pain over their first couple of days after surgery, allowing them to get off to a very good start and not be sick from other medications, be able to eat well and be very mobile overall.
The complications that can occur with this procedure are similar to other surgeries of this magnitude. They include the following: infection, blood loss, nerve injury, loosening of the replacement parts, dislocation and fractures around the implants among others; however, the specialists at the orthopaedic center give you preoperative antibiotics to counter infection, rarely need to give blood transfusions and find that while nerve injury can occur, it is usually temporary (although, a permanent neurologic injury is possible but rare). Also, the components that are placed in the joint can be revised or removed.
Immediately after surgery the patient is encouraged to move the elbow and wrist but shoulder only minimally. The patient typically wears a sling with a slight pillow next to it for approximately four weeks. After this, if the specialist feels there is enough early healing the patient can move their arm more actively as well as perform physical therapy. By four weeks the patient should be able to lift their arm; a full recovery is anticipated by six months.
Due to the nature of this type of procedure, the patient must be careful using their shoulder after the surgery. They are not a candidate for heavy use of their shoulder, such as work on a farm or vigorous yard work. The goal is for the patient to perform daily living activities and routine light exercise.