Disease, rotator cuff

Damage to the rotator cuff, a group of four tendons that stabilize the shoulder joint and move the shoulder in various directions.

A common cause of shoulder pain, rotator cuff disease can be due to trauma (e.g., from falling and injuring the shoulder or from overuse in sports particularly involving repetitive overhead motions), inflammation (e.g., from tendinitis, bursitis, or arthritis of the shoulder) or degeneration (e.g., from aging).

The main symptom is shoulder pain of gradual or sudden onset, typically located to the front and side of the shoulder, increasing when the shoulder is moved away from the body. A person with tears to the rotator cuff tendons may not be able to hold the arm up because of pain. With very severe tears, the arm falls due to weakness (positive drop sign).

The diagnosis of rotator cuff disease can be objectively confirmed by x-rays showing bony injuries from long-standing severe rotator cuff disease; an arthrogram in which contrast dye is injected into the shoulder joint to detect leakage out of the injured rotator cuff; or, preferably, an MRI which can provide more information than an X-ray or an arthrogram.

The treatment of rotator cuff disease depends on its severity. Mild rotator cuff disease is treated with ice, rest, and anti-inflammatory medications (such as ibuprofen). Persistent pain and motion limitation may benefit by a cortisone injection in the rotator cuff. Gradual exercises are instituted that are specifically designed to strengthen the rotator cuff. More severe rotator cuff disease may require arthroscopic or open surgical repair. Subacromial decompression, the removal of a small portion of the bone (acromion) that overlies the rotator cuff, can relieve pressure on the rotator cuff and promote healing. Very severe, complete full-thickness rotator cuff tears require surgery to mend the torn rotator cuff.

Without treatment including exercise, the outlook with rotator cuff disease is guarded. Scarring around the shoulder (adhesive capsulitis) can lead to marked limitation of range of shoulder motion, a condition called a frozen shoulder. Some patients never recover full use of the shoulder joint.

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