| By Dr. Eric Price

 

 

The rotator cuff (see left) is a group of muscles that originates on the shoulder blade (the scapula) and insert on the top of the arm bone (the humerus).

The function of the rotator cuff is to move the shoulder. Often, the rotator cuff is inflamed or torn in people with painful shoulders. People typically complain of difficulty with overhead activities, like reaching for items off a high shelf, brushing the back of the hair or fastening a bra. Often, people have difficulty sleeping on the painful shoulder.

Torn rotator cuff
To evaluate for a rotator cuff tear (see right), a doctor will perform an examination after a history is taken. X-rays are performed, and often an MRI is ordered. The X-rays will evaluate the bones in the shoulder, but not the rotator cuff itself. The MRI will show the muscles and tendons around the shoulder and allow the doctor to see the rotator cuff. If the MRI shows a tear in the rotator cuff, then surgery may be recommended.

Bursitis
If no tear is present, an MRI may show rotator cuff “tendonitis.” Tendonitis is inflammation of the rotator cuff without tearing. This can be responsible for producing shoulder pain. Tendonitis often occurs with "bursitis.” Bursitis (see left) is inflammation of a fluid filled sac (bursa) on top of the rotator cuff that serves to lubricate the movement of the shoulder. The inflamed bursa can be pinched with overhead activities, causing pain.

Bursitis is very common among tennis players. Many factors contribute to bursitis, or rotator cuff inflammation, including poor form, a weak core or overuse, among others. Physical therapy, rest, and anti-inflammatory medications like Ibuprofen are key components of treatment for an inflamed rotator cuff. 

Surgery
If surgery is recommended, it is usually performed arthroscopically. Arthroscopic surgery (see right) uses small incisions and small tools, about the size of a pencil, to perform the procedure. All the work is visualized with a small camera, the arthroscope. The surgeon sees inside the shoulder with the arthroscope and its images are projected on a video screen.

During surgery, rotator cuff tears are repaired (see below) by stitching the torn tendon back to the bone by using an anchor inserted into the bone.

Patients usually go home the same day, often in a sling (see below). Recovery after rotator cuff surgery is gradual. Several months of physical therapy will be required for a proper recovery. Activity restrictions will apply after surgery until appropriate rehabilitation goals have been achieved. Eventually, return to sports will be permitted.

Dr. Eric Price's picture Dr. Eric Price

Dr. Eric Price is a board-certified, fellowship-trained sports medicine specialist with Orlin & Cohen Orthopedic Group. He takes care of all types of athletes, from pee-wee league players to pros and from weekend warriors to triathletes. As an athlete himself, he understands the need to get people back in their game. Dr. Price's expertise includes shoulder arthroscopy for repair of rotator cuff tears, dislocations, knee arthroscopy, including ACL and meniscus surgery. He also teaches shoulder arthroscopy as an Associate Master Instructor for the Arthroscopy Association of North America and as a Laboratory Instructor at several shoulder surgery conferences. For more information, call (516) 536-1212, ext. 213.