ROTATOR CUFF TENDONITIS AND
||Rotator cuff tendonitis and
tears are common disorders of some of the muscles that
control movement of the arm and shoulder. Rotator cuff
tendonitis and tears are collectively known as Impingement
Diagram and Xray of a Normal Shoulder
||The rotator cuff is a series of
four muscles that function to stabilize your shoulder and
allow your arm to move through a full range of motion. The
muscle tendons are lubricated by a fluid filled sac called
the subacromial bursa. Impingement occurs when inflammation
or bony spurs narrow the space available for the rotator
cuff tendons. The syndrome is divided into 3 stages:
Stage I: Swelling and Mild Pain
Stage II: Inflammation and Scarring
Stage III: Partial or Complete tears of the rotator cuff
X-ray and Arthroscopic Pictures of Shoulder
||Rotator Cuff tendonitis and
tears occur from either a sudden violent movement of the
shoulder or from chronic overuse. Sports commonly associated
with this diagnosis include: Tennis, Swimming, Baseball,
Softball and Football.
||The diagnosis of Impingement
Syndrome is considered when patients complain of pain with
overhead arm activities such as a tennis serve or pitching.
The physical exam will reveal weakness of the rotator cuff
muscles and may also show a decreased range of motion of the
shoulder. X-rays are taken to evaluate the bones of the
shoulder. Occasionally, an MRI or shoulder arthroscopy is
used to confirm the diagnosis.
MRI scans of normal and torn rotator cuffs
||Nonoperative: Most cases
of Impingment Syndrome will respond to rest,
anti-inflammatory medication and a directed course of
physical therapy. Resolution of symptoms typically takes
several weeks. Return to full activity may, however, take
several months depending on the severity of the problem.
Occasionally, a steroid injection may also be used to help
alleviate pain in older patients.
Operative: If non-operative measures fail to control
the pain and restore full function, surgery may be needed.
Surgery is done to either remove the scarred and inflammed
tissue (bursitis) and or open up the space available for the
rotator cuff by shaving down spurs (Subacromial
Decompression). Repair or reattachment of torn rotator cuff
tendons may also be necessary.
Two types of surgery are possible. Arthroscopic surgery
involves the use of small instruments and small incisions.
This type of surgery is best for patients with severe
inflammation and partial rotator cuff tears. Full thickness
tears can also be repaired arthroscopically.
Arthroscopic Pictures of a Partial Rotator
Arthroscopic Pictures of Subacromial
Bursitis with removal animation
Picture of operating room during Shoulder
Open surgery involves larger incisions and is more often
required for patients with full thickness rotator cuff
tears. Arthroscopic rotator cuff repair is now more common.
The results in experienced surgeon's hands are now similar
if not better than open methods..
||Prevention of rotator cuff
tears is best accomplished by maintaining a strong and
stable shoulder. Avoiding repetitive overhead activity and
improving the flexibility of the shoulder muscles may also