CONDITIONS TREATED
Rotator Cuff Tendons
Location
There are four flat tendons known as the rotator cuff tendons. Each connect to smaller muscles which pass around the shoulder to then fuse together to encircle the shoulder blade.
Symptoms
Most commonly, rotator cuff problems will cause aching in the top and front of the shoulder, or on the outer side of the upper arm (deltoid area). Pain may be worse if the arm is raised overhead and in severe cases where the rotator cuff is completely torn, the arm cannot be lifted in the forward or outward direction at all. If there is repetitive constriction of the rotator cuff tendon and their lubricating tissue (bursa) when the arm is raised forward, they can become inflamed and swollen. This is called "chronic impingement syndrome".
Diagnosis
Impingement may be caused by genetic problems or trauma. In some people, there is narrowed space between top of the humeral head and the roof of the shoulder blade (or a bone spur on its leading edge), which causes pinching of the rotator cuff tendon, which may break down near its attachment to the humerus and even tear away completely. Apart from impingement, injury in young, active patients may result from sporting activity such as repetitive throwing, overhead racquet sports or swimming, all of these can overstretch the rotator cuff, particularly if inadequate recovery time after exercise is allowed.
Treatment
Physical examination and review of personal medical history will help identify possible causes of rotator cuff problems, but diagnostic imaging is usually required to confirm the focus and extent of damage, for example, an x-ray may show an acromial spur on the shoulder blade causing nerve compression. If the rotator cuff tendons are shown to be injured, impingement tests may then confirm severity and an MRI scan would give a definitive diagnosis.
For minor impingement and tendon pain, rest, physiotherapy and applying ice to the painful area may help reduce inflammation. If imaging shows a bone spur this may be removed arthroscopically (keyhole surgery) along with any minor fraying of the biceps tendon, and scar tissue that may have formed as the tendon tries to repair itself naturally. In cases of complete detachment of the tendon off the bone, arthroscopic surgery may be necessary to stitch the rotator cuff tendon back in place. Recovery will then depend on the type of surgery necessary and the success of any rehabilitation programme.