Rotator Cuff by Dr. Gregg Foos

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Dr. Foos: Hi, I'm Dr. Gregg Foos. I'm here to talk to you quickly about rotator cuff problems today. Rotator cuff is something that an awful lot of people heard about, but not everybody really knows what the rotator cuff is. The rotator cuff are four muscles that come into tendons around your shoulder. They're very helpful and responsible for raising your arm. They do give you strength to be able to lift your arm in the overhead position. Many people think that rotator cuff tears come from traumatic injuries, like falls. Actually, the vast majority of the tears that we see of the rotator cuff come over time, building up from a rubbing of the rotator cuff, and basically, poor blood supply that services the tendon to the cuff. So most of these injuries are small injuries that occur little bits at a time and build up over time. So, oftentimes, we would like to catch these kinds of problems before they become big tears. There's something that we call impingement of the shoulder. Impingement is where the arm comes up and the rotator cuff tendon gets pinched against the bone above the shoulder. In this model right here, this is a shoulder. And basically, what we see are the rotator cuff or the four tendons that surround the shoulder. The first one is in the front, there are two in the back, and there's one on the side. That typically gets pinched against this bone called the acromion above.

One of the things that we oftentimes see as people get older into their 40s and their 50s, this ligament right here will calcify, which gives them a spur in the front part of their shoulder. That spur may not have been there when they were younger, but as we get older, that spur will pinch the tendon particularly as the arm goes into the overhead position. So the constant rubbing of that spur against the tendon irritates the tendon. Impingement starts out as just being inflammation. There's bursitis, the bursa sac around the rotator cuff becomes inflamed, oftentimes giving people discomfort pain particularly when working overhead and particularly when sleeping at night. When that impingement goes on for longer, the rotator cuff tendon becomes partially torn and inflamed, what some people refer to as tendonitis. Once the tear progresses, it can actually tear the tendon off the bone such that the tendon is completely detached from the bone itself.

So that's a process, and it takes time. These kinds of tears don't typically occur in one single event, although that can happen from a fall. Most of these are repetitive overhead use with symptoms that kinda build up over the course of six months to years, in some cases. Obviously, it's best to catch these in the earlier stages. If we can catch these injuries before the tendon tears, we can oftentimes treat it conservatively. That typically means avoiding overhead use, physical therapy, anti-inflammatory medications, and oftentimes, a cortisone injection will help to relieve those symptoms. In patients who we see don't respond to conservative care, we'd like to catch them before the tendon actually tears and remove that spur above their shoulder. That can be done through a small arthroscopic surgery. That means a few tiny little incisions with a camera that gets inserted into the shoulder, and we can remove that spur and clean up any partial tearing of the tendon. That's typically associated with a fairly quick recovery, and most people will be better within two to three months.

The problems we get into are when the tendon is more extensively damaged or particularly when the tendon is completely detached from the bone. Then that's a situation where the tendon has to be reattached. And although that surgery can still be done through small incisions arthroscopically, the recovery is much longer because as we attach the tendon back down to the bone, it takes a long time for that tendon to heal in, such that people after those surgeries, despite the fact they do well, they are oftentimes a prolonged recovery, a longer period of time in a sling, a longer period of time before you can begin using your arm, lifting and gain your strength back. Many people after a rotator cuff repair will find that it's at least a six-month recovery till they're back doing all of their normal activities. So, these are clearly problems that we see with most people building up over time. Much better for patients to really get treatment early on in these kinds of problems so the tendon doesn't detach and that we don't have to do rotator cuff repairs. All right. So that's just a quick synopsis about rotator cuff pathology. Thank you very much for joining us today.

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