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Rotator Cuff Anatomy and Rotator Cuff Injury
The rotator cuff consists of four muscles that attach the "ball" and "socket" of the shoulder. These four muscles are attached to bone by the large rotator cuff tendon.
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When rotator cuff injury occurs, the large tendon that connects four exterior shoulder muscles to bone becomes detached.
For younger patients, a traumatic injury, such as a fall, is the main cause of rotator cuff injury. For elder patients, rotator cuff tears commonly result from "overdoing it" during an activity — lifting too much weight, for example.
Most rotator cuff tears cause pain on the outside of the shoulder. With activity, this pain can radiate to the elbow. Pain worsens at night, and with reaching overhead or lifting. Weakness also may occur.
Diagnosing a Rotator Cuff Injury
An orthopedic physician will take a history of the pain and will ask about activities that worsen the pain, to rule out other shoulder-related conditions.
While a rotator cuff tear will not appear on an X-ray, an X-ray will show whether arthritis is present in shoulder bones.
Conversely, an MRI scan will show whether a rotator cuff is torn, by providing images of soft tissue around the shoulder.
Conservative Treatment for Rotator Cuff Injury
Conservative treatment of shoulder pain starts with physical therapy, to improve range of motion and shoulder strength. Strengthening exercises can rebalance shoulder muscles and decrease pain.
However, rotator cuff tears do not heal naturally. They tend to get larger over time. If exercises don't help, rotator cuff surgery may be necessary.
Rotator Cuff Surgery
Rotator cuff surgery has improved significantly in recent years. It's usually performed on an outpatient basis, with arthroscopy (using a miniature video camera). This lets surgeons examine the entirety of the shoulder's interior — but only a small incision, at the back of the shoulder, is needed.
The orthopedic surgeon will first remove scarring on the bone, if present. For example, a spur will be smoothed out, to stop wear against the tendon.
Next, small anchors are placed in the bone. Then, sutures are passed through the tendon, and attached to the anchors. Finally, the tendon is tied to the bone.
During rotator cuff surgery, the patient is given general anesthetic. Yet, sometimes regional anesthetic is used, as well, to numb the entire arm — starting where the shoulder meets the neck. This can reduce pain for eight to 10 hours after surgery. After regional anesthetic wears off, pain can last up to 72 hours after surgery.
Recovering from Rotator Cuff Surgery
Physical therapy can start two weeks after rotator cuff surgery, to work on passive shoulder motion that won't damage the rotator cuff repair. Reaching or lifting won't be allowed for as long as two months after surgery.
Ultimately, the size of the tear, and the health of the tendon, can play a role in what a patient can do with the arm after surgery.