The rotator cuff tendons are a small group of muscles deep inside the shoulder which holds the shoulder in place while the deltoid muscle moves the arm up and down. The rotator cuff needs to pass underneath the top of the shoulder or acromion bone as the arm is abducted. Many patients will develop irritation of the rotator cuff either due to repetitive overhead activities, or trauma to the shoulder such as a fall or sudden pull on the arm. If the rotator cuff becomes irritated, then patients will develop pain with overhead activities, as the rotator cuff rubs underneath the bone with elevation. This leads to more swelling, more irritation and more rubbing, a condition which causes pain and which is termed an impingement syndrome.
Most patients with impingement syndrome will do well with conservative measures without the need for surgery. This includes a program to reduce inflammation including anti-inflammatory medication, rest, ice and some strengthening exercises with the arm at the side to decrease the shoulder elevation. A corticosteroid injection may also be helpful in relieving inflammation, and as a diagnostic test to help confirm the diagnosis of an impingement. In some patients the pain will persist despite conservative measures, in which case further evaluation such as an MRI scan is performed. The MRI scan may show a rotator cuff tear. Small partial tears can often still be treated conservatively, but complete rotator cuff tears or large partial rotator cuff tears which are symptomatic will often require repair.
Surgical treatment of rotator cuff pathology usually includes a subacromial decompression to remove the pressure on the rotator cuff tendon. If the tendon tear is large, then the rotator cuff is re-attached to the bone using either arthroscopic or open techniques. If a decompression surgery alone is performed to remove the bone spur, and a rotator cuff repair is not necessary, then recovery is fairly rapid with immediate resumption of motion, and approximately a two to three month time until the patient can return to full activities.
When a rotator cuff repair is performed, the patient needs to be in a sling for approximately four to six weeks, and is unable to actively abduct the arm for approximately six weeks. Recovery from rotator cuff tears is much slower, and it may be four to six months until the patient is returned to full function. For very large tears, recovery time may be greater than one year. Even with repair of a rotator cuff tear, the patient may still have some weakness and loss of motion, although pain relief is generally significant, particularly pain at night.
