The shoulder joint is a complex, well-designed structure that allows a great range of motion for the upper extremity. With its significant mobility comes the risk of inflammation, instability, or damage if an injury occurs during sporting activities or from natural degeneration. The rotator cuff is a vital structure located around the shoulder joint and is composed of four muscle-tendon units that help stabilize the shoulder. A rotator cuff tendon can become torn from natural degeneration, overuse or an acute injury. A rotator cuff tear leads to a weakened shoulder joint and the inability to perform many arm movements. Dr. Jonathan Ticker, orthopedic shoulder surgeon, specializes in injuries to the shoulder joint, such as a rotator cuff injury. He takes great pride in treating Long Island, Brooklyn, Queens and NYC area patients who have injured their rotator cuff so they can return to an active, healthy lifestyle.
The four muscle-tendon units of the rotator cuff surround the shoulder joint and help provide overhead motion of the arm. The rotator cuff also helps stabilize the shoulder so individuals can perform normal, everyday activities and compete in sports. A rotator cuff injury, most commonly a tendon tear from its attachment site on the humerus head, can occur when any of the four units become injured.
Common causes of a rotator cuff tear include:
- An acute injury such as a hard hit or traumatic fall during athletic activities, or a work or an automobile accident
- Chronic, continuous overuse that occurs with athletic training, such as baseball (pitching), or performing overhead movements in tennis, swimming or work-related activities
- The gradual degeneration and aging of the muscles or tendons over time can cause a breakdown of collagen, thus making the tendons and muscles more prone to an injury
A torn rotator cuff is also associated with other shoulder conditions such as tendonitis and impingement. Surrounding bony structures can contribute to tendon injury and tearing.
Symptoms of a Rotator Cuff Tear
Rotator cuff symptoms vary from patient to patient depending on the anatomic location and severity of the injury. The hallmark symptom of a rotator cuff injury is pain over the top of the arm and shoulder. Certain patients may also experience pain that travels down the arm towards the elbow joint. Patients often report a loss of sleep linked to increased pain while at rest lying on the injured joint.
Another common symptom of a rotator cuff tear is joint weakness. The weakness may become so severe it hinders the ability to perform overhead motions, such as reaching overhead while getting dressed or grasping an object.
Diagnosis of a Rotator Cuff Injury
In order to diagnosis a rotator cuff tear, Dr. Ticker will perform a physical examination to look for joint deformities, muscle wasting and tendon weakness. During the physical examination, he will manipulate the injured shoulder to find areas of pain and tenderness, as well as to determine overall strength and mobility. Dr. Ticker will also perform a series of x-rays and an MRI scan to view the bony and soft structures in great detail.
Treatment of a Rotator Cuff Tear
Rotator cuff tear treatment is dependent on injury severity, patient’s age and patient’s activity level. The overall goal of non-surgical and surgical treatment is to reduce inflammation and pain, strengthen the surrounding uninjured structures and to improve overall function.
If the rotator cuff injury is not severe, Dr. Ticker may prescribe a conservative treatment approach. Patients will be instructed to rest the affected arm while utilizing a combination of ice, heat and anti-inflammatory medications. Physical therapy may also be prescribed to help strengthen the uninjured soft structures to help compensate for the torn structure. In many patients, Dr. Ticker may also utilize an ultrasound assessment and an ultrasound guided injection to improve treatment accuracy and to help decrease pain.
A rotator cuff tear may require an arthroscopic surgical approach if the tear is too severe or does not heal with conservative treatment. An arthroscopic repair is performed through a series of small incisions, termed portals, in and around the damaged area. Dr. Ticker will utilize these portals to introduce instruments with repair devices to re-attach the torn tendon to its original attachment site on the humeral head. An arthroscopic approach is minimally invasive so patients are able to recover more quickly with less pain and complications.
For more information on a rotator cuff injury, or to discuss treatment options for a rotator cuff tear, please contact the orthopedic office of Dr. Jonathan Ticker, shoulder specialist proudly serving the greater Long Island, Brooklyn, Queens and NYC communities.