The shoulder is a ball and socket joint made up of the scapula (shoulder blade), clavicle (collarbone), and humerus (upper arm bone). The scapula forms the socket while the head of the humerus forms the ball, enabling full range of motion for the arm.
A group of four tendons and muscles called the rotator cuff maintain stability of the shoulder joint, preventing the humerus from sliding out of the socket bone (dislocation). The rotator cuff attaches the humerus to the shoulder blade and helps to lift and rotate your arm.
Rotator cuff tears can occur suddenly or gradually. When the rotator cuff is torn, pain, weakness and altered range of motion can result.
Trauma, degeneration and aging can cause the rotator cuff to tear. A Rotator cuff tear is a common cause of shoulder pain and weakness in middle-aged and elderly people. However, it can occur at any age from injury.
Rotator cuff tears commonly occur from the following:
Rotator cuff tears cause pain in the shoulder with swelling, weakness, tenderness and altered range of motion.
Rotator cuff tears can be of two types: partial or complete. With a partial tear, you will experience pain, but will still be able to move your arm. A complete tear involves detachment of the tendon from the humeral head and the inability to move the arm normally.
When you visit your doctor with complaints of shoulder weakness and pain, your doctor analyzes your medical history and performs a thorough examination of your shoulder. Your doctor may order imaging tests such as X-ray’s, MRI or ultrasound to confirm a diagnosis of rotator cuff tear. Sometimes, a shoulder arthrogram is performed, where a dye is injected into the shoulder joint and a series of X-ray images are taken.
Non-surgical treatment of rotator cuff tears are initially recommended to alleviate pain and improve shoulder function. Your doctor may suggest the following measures:
Surgery for a rotator cuff tear is advised when:
Rotator cuff repair involves stitching the torn tendon back onto its attachment to the arm bone (humerus).
Surgery for a rotator cuff tear can be performed through open or minimally invasive methods. The traditional open surgery involves a large incision over the shoulder, whereas the minimally invasive method involves 3 to 4 small incisions around the joint through which an arthroscope, a long, narrow instrument with a lens, light source and camera attached to its end, is inserted.
The arthroscope provides a clear view of the surgical site which is displayed on a monitor for your surgeon to view. Small surgical instruments are introduced through the other incisions to perform the surgery and repair the damage.
The benefits of arthroscopy compared to the alternative, open shoulder surgery, include:
As with any surgery, there are risks, and complications can occur.
Along with the risks of anesthesia, possible risks and complications associated with rotator cuff surgery include:
Rotator cuff tears are a common cause of shoulder pain in middle aged and elderly people. They may occur from injury or degenerative changes that occur with aging.
Treatment depends on the severity of the tear. Rest, pain medications, and shoulder strengthening exercises may provide relief in cases of partial tears but complete tears may require surgery.
Surgery can provide relief from the pain in most cases, but recovering the functional mobility of the shoulder joint can vary from individual to individual and depends on active participation in post-surgical rehabilitation exercises.