What is the Rotator Cuff?
The rotator cuff is a ‘cuff’ of tendons that surround the shoulder joint. It is made up of four muscles: supraspinatus, infraspinatus, subscapularis, and teres minor. These muscles control the fine motion and strength of the shoulder joint.
How is the rotator cuff injured?
The rotator cuff can be injured as a result of normal wear and tear (“degenerative” injuries or tears) or as a result of a fall or accident (“traumatic” tears).
How to Treat it?
Treatment of a rotator cuff tear is dependent on how much it affects the patient and what the tear pattern is. Conservative, or non-operative treatment, is usually first.
Non-Operative Options
Observation
- Partial rotator cuff tears that do not significantly affect the patient’s function or quality of life can be treated without surgery.
- Full thickness rotator cuff tears that do not significantly affect the patients function quality of life can be treated without surgery. Because these are full-thickness tears some will need to be monitored over time.
Anti-Inflammatory Medications
- Some of the pain from a rotator cuff tear is due to inflammation. Takin over the counter or prescription anti-inflammatory medications can help relieve the pain.
Corticosteroid Injection
- A corticosteroid injection is a potent anti-inflammatory medication targeted directly at the rotator cuff tear in the shoulder joint and can provide pain relief. This will not heal the tear, but it may decrease the inflammatory pain and allow the patient to progress with non-operative treatment and/or physical therapy.
- These injections can be done every 3-4 months. More frequent injections may cause tendon and cartilage damage.
Physical Therapy
- Physical therapy can help with inflammation and it also helps ‘reset’ the shoulder’s mechanics. It will help strengthen the uninjured muscles and tendons to compensate for the ones that are torn. This ‘resetting’ of shoulder mechanics can help shoulder function and improve strength.
Surgical Options
Reparable Tears
Arthroscopic Rotator Cuff Repair
- The rotator cuff is repaired using sutures and anchors that bring the tendon back down to the bone.
- For an animated summary of the repair, please visit here.
Irreparable Tears
Superior Capsular Reconstruction
- The rotator cuff is repaired using sutures and anchors that bring the tendon back down to the bone.
- For an animated summary of the repair, please visit here.
Lower Trapezius Tendon Transfer
- For irreparable rotator cuff tears, a lower trapezius tendon transfer may be an option to improve pain, function, and strength
Reverse Total Shoulder Arthroplasty
- For irreparable rotator cuff tears, a reverse shoulder replacement is a reliable solution for pain relief.