The rotator cuff consists of four muscles. These are: Supraspinatus, Infraspinatus, Teres Minor and the Subscapularis. These are the muscles that keep the humeral head centered in the glenoid. They are also very important in overhead activities such as throwing, swimming, serving, etc.
The most common symptom of a cuff tear is inability to hold arm up above shoulder level or perform activities above shoulder level. The patient could also have general muscle weakness with the shoulder musculature. Decreased range of motion as well as “grinding” may also be symptoms.
How do you tear the rotator cuff?
Rotator cuff tears can be either acute (new) or chronic (old). Many times, the patient my or may not remember an incident that led to the shoulder pain. You can get tears of the rotator cuff through extended overhead activities or via a fall. There are other things that can lead to a tear, but these are the most common.
Diagnosing Rotator Cuff Tears
As with any injury, a thorough history and physical examination with x-ray is the first step. If it is felt necessary, an MRI may be ordered. It needs to be noted that in order for the MRI to be most effective as a diagnostic tool, contrast medium needs to be injected into the shoulder joint. In the MRI picture below, you see the shoulder if you were looking at it from the front. Inside the red circle, you will see where the rotator cuff has torn. The tendon is no longer attached to the humerus and has actually retracted back from the bone. The white that you see, is the contrast medium. Dependant upon how many cuts (the individual pictures of those views on the MRI) that the tear is seen in, shows Dr. Lowe how much of the cuff is involved (full thickness or partial thickness tear) and how to best treat the injury.
The majority of the time, rotator cuff tears can be repaired arthroscopically. Occasionally, the tear is such that it needs to be repaired open. This means that a larger incision needs to be made to give Dr. Lowe access to the torn area of the muscle(s). Again, suture anchors will be placed in the bone, and the torn tendon will be suture back down to the humeral head.
Normal Rotator Cuff
Tear of Rotator Cuff
Sutures being passed through tendon
Repaired Rotator Cuff
Here is an illustration of the repairing of a rotator cuff tear. Each tear / injury is treated individually. Dr. Lowe will asses the most appropriate way to repair each specific pathology. This is just a generic representation as is not necessarily indicative of how Dr. Lowe may actually perform the procedure.
The rehabilitation following Rotator Cuff repair is just as important as the surgery itself. Typically following this procedure, the patient is in a sling with a wedge attached to keep the arm away from the side. This is to be worn at all times for the first month or longer following the procedure. Also following the surgery, the patient will begin formal physical therapy. Initially the therapy will consist of the therapist moving the shoulder for the patient. This is done to prevent the shoulder from becoming stiff, but done in such a way to protect the repair. After the appropriate period of time, the patient will then be allowed to come out of the sling and slowly begin doing more active work with the shoulder. Return to activities such as throwing and lifting weights is determined by Dr. Lowe on a patient to patient basis. To get a better idea of what is involved in the rehabilitation process, you can view the protocols that are on this site.