By Dr. Edmond Cleeman (Manhattan Orthopedics Sports & Medicine Group)
Rotator cuff tendon injury is a spectrum of disorders ranging from simple inflammation of the bursa (fluid sac that helps gliding between surfaces), degeneration/breakdown of the tendons, partial tears, complete tears of the rotator cuff tendon, and finally rotator cuff arthropathy (development of shoulder arthritis as a result of long standing rotator cuff tendon tears). We will focus on complete rotator tendon tears in this discussion.
Patients typically are over 40 years of age and complain of weakness, pain, snapping/crackling with motion and stiffness of their shoulder. Most do not have a traumatic episode leading to the injury. Some patients just wake up one day with symptoms but most are active and participate in overhead sports or activities and develop symptoms as a result of repetitive overuse. Patients have difficulty and pain with sport activities like throwing, serving tennis balls, and swimming. The pain can also interrupt sleep. As time goes on weakness gets worse, stiffness may develop, pain can intensify and become constant. Patients may develop pain with basic activities of daily living such as lifting a carton of milk, fastening a bra, tucking in a shirt, combing their hair and others.
So what is the rotator cuff? The shoulder is a ball and socket joint. There are four tendons that move the shoulder and they are called the rotator cuff tendons. Tendons are the structure that attaches muscle to bone. Covering the entire rotator cuff is a bursa, a paper-thin fluid sac that helps gliding occur with less friction between surfaces. Covering all of this is another muscle called the deltoid.
Shoulder Anatomy
Fig 1. Bony anatomy of the shoulder
Fig 2. Soft tissue anatomy of the shoulder
Fig. 3 Inflammed bursa and rotator cuff tendon tear
