Anatomy of the Rotator Cuff
The shoulder joint is a highly mobile joint that allows the largest range of motion of any joint in the body. The power for the motion of the shoulder is provided by the muscles around the joint. A group of four muscles collectively known as the “rotator cuff” provide strength for movement in addition to stability by compressing the ball into the socket. These muscles are named as follows:
- Teres minor
Pathology of a Rotator Cuff Tear
They contribute to the motions of forward flexion (bringing arm in front of a patient), abduction (bringing arm out to the side), internal rotation (reaching behind the back), and external rotation (reaching behind the head). If any of these structures are damaged or injured, a loss of mobility of the shoulder joint may occur, accompanied by severe pain. Injuries to the rotator cuff are very common in athletes due to overuse of the shoulder and acute trauma. These tears are also commonly seen as a patient ages. Shoulder specialist Dr. Robert Boykin focuses on the treatment of rotator cuff injuries for patients in Asheville, Arden, Fletcher and surrounding North Carolina communities. The tears can be grouped into two categories:
- Acute tear– When the rotator cuff becomes injured due to a fall, sports related trauma, or an accident such as a motor vehicle collision.
- Degenerative tear – As a patient ages, so do the muscles and tendons surrounding the joints. Over time these become weaker, increasing the risk of a rotator tear even without major trauma.
The spectrum of rotator cuff disease progresses from tendonitis (inflammation) to partial tearing to full thickness tearing.
Symptoms of a Rotator Cuff Tear
Symptoms associated with a rotator cuff injury are a direct result of the damage to the muscles surrounding the shoulder and the inflammation that accompanies it. Some symptoms associated with a rotator cuff injury are:
- Chronic aching pain
- Pain at night
- Inability to lift the arm and perform normal daily activities
- Limited range of motion
How to Diagnose a Rotator Cuff Injury
In order to determine the severity and thus the proper treatment of a rotator cuff injury, Dr. Boykin will perform a complete examination of the shoulder by assessing range of motion, strength, and muscle loss in addition to reviewing X-rays. Specific tests for rotator cuff injuries include the Jobe test, Lift off sign, Belly press test, and the Hornblower sign. After the initial examination, Dr. Boykin will most likely order a MRI to confirm the diagnosis, visualize the extent of injury, and determine the quality of the muscle.
Following a diagnosis of the injury, Dr. Boykin will present a patent with their treatment options. The best treatment option for a rotator cuff injury is dependent upon the severity and nature of the injury. The ultimate goal is to reduce the inflammation and pain associated with the tear and restore function to the shoulder. Rotator cuff tendonitis is first treated with non-operative measures including rest, physical therapy, anti-inflammatory medications, and potentially an injection of corticosteroids. Partial thickness tears, small full thickness tears, and chronic tears may also be first treated with conservative measures.
Treatment Options for a Rotator Cuff Injury
If non-surgical treatment methods do not prove to be beneficial or in the cases of acute full thickness tears Dr. Boykin may recommend surgery. Dr. Boykin will present the options and discuss which surgical treatment will benefit the patient by taking into account the age, lifestyle, and goals of the patient.
If a decision for surgery is made, arthroscopic surgery for the rotator cuff will likely be performed through a number of small incisions through which Dr. Boykin will insert a camera and special surgical instruments in order to repair the tearing. Arthroscopic shoulder surgery allows a quicker recovery and less post-operative pain than open techniques.
In more severe cases, Dr. Boykin will may need to make an open incision and will repair the damage to the shoulder. This surgery is performed if the damage requires a more extensive or different type of repair than can be accomplished through an arthroscopic approach.
For additional resources regarding rotator cuff injuries, or for information on other shoulder injuries and treatment approaches, please contact the office of shoulder specialist, Dr. Robert Boykin, orthopedic shoulder, knee, and hip surgeon serving Asheville, Arden, Fletcher and surrounding North Carolina communities.