Rotator Cuft Injury
Shoulder pain can often result in stiffness or a decrease in the range of motion which can interfere with our daily activities or our jobs. Such shoulder pain can be caused by the injury to the rotator cuft, the injury to the biceps tendon, or the damage of the cartilage called labrum in the shoulder.
The shoulder is covered and stabilized by four muscles collectively called the rotator cuft. A heavy lifting, pulling or pushing can injure the rotator cuft since it can be impinged under the shoulder bone called acromion, especially if the acromion becomes thickened or curved. Such injury causes the rotator cuft to be inflamed and swollen resulting in painful and limited range of motion of the shoulder. These symptoms are usually diagnosed as the Impingement Syndrome. The limited range of motion is defined as the Adhesive Capsulitis.
The person with a rotator cuft injury typically complains of pain in the shoulder or pain at the upper forearm. Some patients may complain of a pain at the base of the neck.
By a careful physical exam, a physician can distinguish the shoulder pain from the neck or forearm pain.
Radiographic pictures are usually obtained to rule out any bone abnormality. A MRI of the shoulder can be ordered to evaluate the degree of the rotator cuft injury or to confirm any damage to the labrum.
For the Impingement syndrome, a physical therapy treatment for one to three months is needed to regain the range of motion, to relieve the pain and to strengthening the rotator cuft. Steroid injections can be offered to decrease the inflammation and pain besides the nonsteroidal anti-inflammatory medications.
If such treatments do not relieve or improve the symptoms, an arthroscopic procedure to remove the bonny impingement from the rotator cuft is recommended.
If the MRI reveals that the rotator cuft is partially torn more than 50% of its thickness or completely torn, an arthroscopic operation will be recommended since such tears will not heal by nonsurgical treatments. Even with the surgical repair the rotator cuft can take up to 12 months to heal completely.
The shoulder arthroscopy is an outpatient same day procedure. The orthopedic surgeon usually performs this procedure under the general anesthesia. However, the regional nerve block can be added to control the pain few days after the procedure.
During the arthroscopic procedure, the surgeon introduces a thin camera and instruments through few small incisions. The surgeon can visualize the shoulder space and structures, repair any cartilage or ligament injury, remove any scar or inflamed tissue, remove bone spurs and repair the rotator cuft tear.
The physical therapy treatment is recommended after the arthroscopy to regain the shoulder motion and strength.
If the MRI reveals a massive unrepairable rotator cuft tear, a physical therapy regiment is recommended. If the patient cannot improve his active abduction more than 90 degrees (pseudoparalysis), a total reverse replacement is recommended. Such procedure enables the patient to use the deltoid muscle instead of the rotator cuft to elevate the affected shoulder.
For a very active patient with a massive rotator cuft tear, an allograft tissue (a tissue from a donor) can be used to cover the defect in the rotator cuft. Such allograft can provides enough stability for the remaining portion of the rotator cuft to lift up the shoulder.
For the patient with the biceps tendon injury, if the physical therapy fails to relieve the symptoms, a debridement or reattachment to the upper forearm through an arthroscopy can be performed to relieve the pain.
In conclusion, the shoulder pain should not be ignored since it can result in the severe consequences such as chronic pain, progressive stiffness and weakness. The treatment of the shoulder pain should include careful physical exams, radiographic studies, oral medications, injections and possible surgical treatments.
Dr. Chau received his orthopedic training at the University of Virginia and did his Fellowship at the Cleveland Clinic under Dr. Lester Borden, He is certified by the American board of Orthopedic Surgeons and specializes in total joint replacement surgery of the hip, knee and shoulder. He has practiced in the Sugar Land area since 1996.