1. Anatomy and Function - Composed of THREE muscles DEEP to the Deltoid Muscle:
A) Subscapularis - Origin = front of scapula.
Insertion = lesser tuberosity of Humerus.
Location = front of shoulder joint.
Function = Internal Rotation of Humerus.
B) Supraspinatous - Origin = back of scapula (above scapular spine).
Insertion = greater tuberosity of Humerus.
Location = top of shoulder joint.
Function = External Rotation of Humerus and Humeral Head
Depressor during arm elevation.
C) Infraspinatous - Origin = back of scapula (below scapular spine).
Insertion = greater tuberosity of Humerus (behind supraspinatous)
Location = back of shoulder joint
Function = External Rotation of Humerus.
2. Injury - there are TWO degrees of injury to the Rotator Cuff:
A) Impingement Syndrome - the Supraspinatous tendon is impinged against the
undersurface of the Acromion as the arm is elevated.
This may occur due to trauma or due to aging and
weakening of the supraspinatous. The result is pain
and swelling of the tendon (Tendinitis) and the
surrounding bursa (Bursitis).
CLICK ON PICTURE TO SHOW
B) Rotator Cuff Tear - a tear in any one of the Three Rotator Cuff tendons due to
3. Treatment -
A) Impingement Syndrome
Nonsurgical - initial treatment consists of injection of a cortisone
derivative into the subacromial space to reduce swollen
tissues and relieve pain. This is followed by a Rotator
Cuff strengthening exercise program to help keep the
Humeral Head depressed during elevation of the arm
thereby preventing another impingement episode.
Surgical - if the above plan is unsuccessful in eliminating the problem, then
4. Biceps Tendon - the long head of the Biceps Muscle takes its Origin with the tendon as part of the Superior Glenoid Labrum. As such, aportion of the tendon spans the roof of the shoulder joint
A) Tenodesis - the tendon is cut at its origin on the Glenoid Labrum and re-
attached in the Bicipital Groove. This eliminates the part
spanning the joint, thereby stopping the friction and pain.
This is done via a 2 inch incision and recovery is the same
as for Rotator Cuff Repair.
B) Tenotomy - the tendon is cut at the labrum and not re-attached. This is only
done in the elderly, sedentary patient.
A) Non-surgical Treatment - Most times the tear is left alone and the patient is
treated with shoulder rehab. These cases do well
with very little (if any) residual pain and weakness.
They will be left with a bump in the upper biceps
that is permanent (Popeye Arm).
B) Surgical Treatment - if treated early (within 6 weeks of injury), a young
active patient may have repair by Tenodesis (see above).
The incision will need to be about 6 inches long to
allow for retrieval of the torn tendon from down the arm.
Rotator Cuff Repair
5. Adhesive Capsulitis (Frozen Shoulder) - this condition is heralded
by painful loss of shoulder motion. Common in middle-aged (or older)
females, this usually begins as an Impingement Syndrome or Bursitis. Next,
due to lack of use, the capsule of the shoulder thickens and shortens, thereby
causing painful loss of motion.
A) Non-surgical Treatment - cortisone injection and aggressive physical
therapy for passive shoulder motion. This may require multiple injections and
months of therapy but should continue as long as progress is being made.
B) Surgical Treatment - if needed, Manipulation under General
Anesthesia is performed. The shoulder gently pushed and pulled into
full range of motion with the patient asleep in the operating room. If unsuccessful,
thearthroscope is introduced into shoulder and the capsule is cut
(Capsulotomy). Either way, the patient is sent home after the procedure
and Physical Therapy is begun the next day.
Click below to view 3 short clips on a Rotator Cuff
B. Rotator Cuff Tear
Nonsurgical - this envolves strengthening the muscles of the shoulder that are not torn to
Surgical - Rotator Cuff Repair is the treatment of choice to restore the anatomy and function of the
torn tendon(s). The bone of the tuberosity is prepared by abrading it to bleeding surface,
then the torn tendon is re-attached to it using suture anchors. A subacromial
decompression is usually done also. In the past, Rotator Cuff Repairs were always done
through an incision whereby the Deltoid muscle had to be cut or split to expose the repair
site (Open). Within recent years, more and more of these surgeries are being performed as
an Arthroscopic Rotator Cuff Repair. Four small stabs are made for the arthroscopic
access cannulas. The surgery is done as an OUTPATIENT procedure and takes one to
two hours under general anesthesia. A shoulder immobilizer is worn for 6 weeks and
Physical Therapy is needed for 2 to 3 months. Full recovery can take 3 to 6 months
depending on the size of the Rotator Cuff Tear. (See Protocol)
Advantages of Arthroscopic Rotator Cuff Repair include:
1. Improved visualization and mobilization of torn tendons
2. Less surgical trauma to the deltoid muscle
3. Less post-op pain
4. Improved shoulder motion in critical early post-op period
5. Improved cosmetic appearance of the shoulder after surgery
Dr. Yacobucci has received advanced training in Arthroscopic Rotator Cuff Repair from leading experts and performs his Rotator Cuff Repairs Arthroscopically
Complete Biceps Tendon Tear - Very little pain after a few months. Options are: