The shoulder, in my opinion, is probably the most magnificent joint in the body. Its amazing range of motion, flexibility, and strength are stunning, especially when it comes to gymnastics, golfing, and weightlifting, to name a few. It’s an absolute marvel of biomechanics to have such a large ball in such a shallow socket. What makes it all possible is the rotator cuff.
The rotator cuff is made up of 4 muscles and their tendons that hold the shoulder joint together. These muscles endure a lot of stress, however, because the structure of the shoulder joint is so unstable. From overhead lifting to throwing softballs to using a jackhammer: these activities all put a tremendous amount of stress on the shoulder. This is why certain athletes, like baseball players and weightlifters, and people in certain trades, like carpenters and painters, are prone to rotator cuff injuries.
Injury to the rotator cuff involves either a partial tear or a full tear of any of the tendons. For example, if you fall onto an outstretched arm, this could pull the tendon from the bone and cause a hole to form in the tendon. Or, the tendons could simply wear down over time due to repetitive stress or decreased blood flow, which can cause scarring and tears.
Typically, people with rotator cuff injuries experience pain, stiffness, weakness, and cracking or crunching when lifting or lowering their arm. In this case, they need to consult their doctor, who will perform a careful physical exam to make sure the pain isn’t actually caused by something in the neck or elbow. The diagnosis can also be based on patient history and x-rays, which check for tears, arthritis, or calcium in the tendon. An MRI or ultrasound may be needed for more detailed information.
If it is a small tear, most doctors will want to treat it conservatively for 4 to 6 weeks in order to avoid surgery, recommending rest and decreased activity, ibuprofen or Aleve, and possibly physical therapy and/or a steroid injection for the inflammation.
If it is a tear larger than 3 cm or is a chronic condition, your doctor may recommend surgery. Most cases can be eligible for arthroscopic surgery (as with knee surgery), which requires fewer and smaller incisions, with less risk of infection, fewer muscles impacted, and shorter recovery time. However, if it is a large tear that requires more work on the tendons, it may require open surgery.
The rotator cuff is an anatomical wonder. Just remember that the next time you high-five someone or dance to YMCA or cram your carry-on luggage into that tiny overhead compartment. Your shoulder can perform marvelous deeds because of the magnificent rotator cuff.
If you’d like more information, or to schedule an appointment with Dr. Beth Dollinger, click here to find her contact information listed in our provider directory.