Rotator Cuff Syndrome

The rotator cuff tendons keep the humeral head in place while the arm  goes through its various ranges of motion. Rotator cuff syndrome refers to any pathology that affects the rotator cuff tendons’ ability to function.  The supraspinatus, one of four rotator cuff muscles, is most often affected.

Causes

Repetitive overuse: stressing the shoulder joint with the arm over the head is the most common cause in young people. Activities such as freestyle swimming, basketball, tennis, and throwing sports are often to blame. Other overuses include unaccustomed decorating, carpentry, and weight training

Trauma: a fall on the shoulder or outstretched arm, especially in the elderly, can tear the rotator cuff tendons with symptoms identical to rotator cuff syndrome.

Abnormally shaped acromion: some patients have a pronounced dip at the tip of the acromion into the subacromial space, making impingement of the rotator cuff tendons more likely on lesser degrees of use

Shoulder instability: recurrent dislocation of the shoulder can cause repeated impingement of the rotator cuff tendons

Impingement of the rotator cuff tendons: impingement occurs between the humeral head and the acromion or coracoacromial ligament

Symptoms

Pain and tenderness in your shoulder, especially when reaching overhead, reaching behind your back, lifting, pulling or sleeping on the affected side

Shoulder weakness

Loss of shoulder range of motion

Inclination to keep your shoulder inactive

The most common symptom is pain. You may experience it when you reach up to comb your hair, bend your arm back to put on a jacket or carry something heavy. Lying on the affected shoulder also can be painful. If you have a severe injury, such as a large tear, you may experience continuous pain and muscle weakness.

Procedures

Procedural options include cortisone injections to the subacromial bursa if the rotator cuff injury is bursal-sided, injections to the glenohumeral joint if the pathology is articular-sided. These injections help with pain but may actually weaken the tendon.  The relief may be temporary.  It can provide longer lasting relief if the condition is treated in conjunction with physical therapy.  The pain relief will allow for better participation in therapy. Regenerative-type injections (such as platelet-rich plasma [PRP] or stem cell injections) can theoretically provide longer lasting pain relief and improved function by stimulating the body’s own natural healing response.

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