1. Anatomy and Function - Composed of THREE muscles DEEP to the Deltoid Muscle:
Location = front of shoulder joint.
Function = Internal Rotation of Humerus.
Location = top of shoulder joint.
Function = External Rotation of Humerus and Humeral Head
Depressor during arm elevation.
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:
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
CLICK ON PICTURE TO SHOW
ENLARGED VIEW
B) Rotator Cuff Tear - a tear in any one of the Three Rotator Cuff tendons due to
trauma (fall or collision) or degeneration / aging. Another
mechanism of tear peculiar to the Supraspinatous tendon is
longstanding untreated Impingement Syndrome. Once torn,
Rotator Cuff tendons CANNOT HEAL due to their very poor
blood supply.
3. Treatment -
tissues and relieve pain. This is followed by a Rotator
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
Shoulder Arthroscopy with Subacromial Decompression is performed.
This is an outpatient procedure done with 2 or 3 tiny incisions. The
Subacromial bursa is removed and the acromion is shaved with a
high-speed burr to remove a wedge of bone from the undersurface
at it's front end. This will increase the space available for the
Rotator Cuff by up to 300% and prevent future Impingement. The
recovery involves a sling for a few days followed by 4 to 6 weeks
of Physical Therapy to regain shoulder motion and Strength.
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
before it exits via the Bicipital Groove at the top of theHumerus. This groove has a roof
across the top formed by the firm transverse ligament. It is inthis groove that the Biceps Tendon can be damaged by attritionor injury.
Biceps Tendinitis - inflammation of the tendon in the Bicipital Groove. Treatment
consists of NSAIDS, cortisone injection and Physical Therapy.
Partial Biceps Tendon Tear - a very painful lesion which usually requires surgery:
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.
done in the elderly, sedentary patient.
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).
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.
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.
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.
Repair
B. Rotator Cuff Tear
Nonsurgical - this envolves strengthening the muscles of the shoulder that are not torn to
compensate for the torn rotator cuff muscle(s). This is only done in situations where
the patient is not a good surgical candidate due to high risk medical problems or
advanced age. The tear will not heal and will continue to enlarge causing progressive
deterioration of the shoulder joint.
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)
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
