Dr Rahul Aggarwal
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ROTATOR CUFF

What is Rotator cuff?

Rotator cuff is a composite name to a group of four tendons and their muscles attaching to proximal humerus.

  • Subscapularis
  • Supraspinatus
  • Infraspinatus
  • Teres minor

What are function of rotator cuff:

  1. It holds humeral head into shallow, small glenoid fossa of scapula.
  2. Movement of humerus at shoulder joint.

What are symptoms of cuff problems?

  1. Shoulder pain
  2. Shoulder stiffness
  3. Loss of strength in the affected arm
  4. Inability to lift your arm.
  5. Clicking sound when raising your arm

What can be problems in rotator cuff?

Tendinopathy: Tendinitis and Impingement.

  • Inflammatory lesions pertaining to rotator cuff tendon.
  • Causes: Injury, exercises, sleeping over the shoulder overnight, participating in overhead activities, degenerative.
  • Examination: Swelling, wasting of muscle, shoulder range of motion, muscle strength.
  • Specific clinical tests.   USG/ MRI/ MRI Arthrogram Shoulder.

 Treatment:

  • Conservative:
  1. Rest to part.
  2. Apply Ice to affected shoulder. Preferably 3-4 times a day.
  3. NSAIDs to reduce inflammation and relieve pain.
  4. Intra articular and periarticular steroid injections- to reduce inflammation and pain. (acute stage)
  5. Physiotherapy – USG therapy/ Laser therapy/ TENS etc.
  6. Intra lesional PRP (Platelet Rich Plasma) injections for chronic lesions.
  • Surgical: Arthroscopic sub acromial decompression: Recurrent and recalcitrant Impingement cases.

Tear:

  • Breach in continuity of rotator cuff.
  • Acute: New tears caused by a significant injury. Onset is sudden, duration is short, and symptoms are severe.
  • Degenerative: Tears in aged (worn out) cuff tendons. Can be both traumatic or non-traumatic. Onset is slow, duration is long and symptoms are mild.

  Diagnosis:

   Examination:

  1. Swelling, wasting of muscle, bruises, fracture around shoulder.
  2. Shoulder range of motion, muscle strength.

  Specific clinical tests.   USG/ MRI/ MRI Arthrogram Shoulder.

Treatment:

  • Conservative:
  1. Rest to part. Immobilise by sling/ strapping.
  2. Apply Ice to affected shoulder. Preferably 3-4 times a day.
  3. NSAIDs to reduce inflammation and relieve pain.
  4. Intra articular and periarticular steroid injections- to reduce inflammation and pain. (acute stage)
  5. Physiotherapy – USG therapy/ Laser therapy/ TENS etc.
  6. Gradual joint mobilisation once symptoms start improving.
  7. Intra lesional PRP (Platelet Rich Plasma) injections for chronic lesions.
  • Surgical:
  1. Partial Tears:
  1. Timing of surgical intervention is not well defined.
  2. Younger patients and those with failed conservative treatment for 3–6 months need surgery
  3. Technique mostly used is arthroscopic repair by suture anchors.
  1. Complete tears:
  1. Techniques mostly used for repair are open repair, mini open repair and arthroscopic repair.
  2. Specialised suture anchor devices are utilised to fix torn cuff tissue to the raw bone surface. Various material anchors are available such as titanium, peek, bio-composites.