Shoulder-Rotator Cuff Tear

The rotator cuff is comprised of four muscles and their tendons which insert on the top of the humerus or arm bone. They function along with the deltoid to elevate and rotate the arm. The four muscles, beginning in the front and moving up over the top to the back are the subscapularis, the supraspinatus, the infraspinatus and the teres minor. The subscapularis muscle inserts along the superior neck of the humerus at a bony prominence termed the lesser tuberosity. The supraspinatus, infraspinatus and teres minor insert in that order along individual ridges of another prominence termed the greater tuberosity.

Rotator cuff tears may involve one or all of the aforementioned muscles and essentially involve separation of their attachment onto their respective bony prominences. The most commonly involved tendon in rotator cuff tears is the supraspinatus tendon.

Rotator cuff tears can be caused by severe trauma such as experienced during a high speed motor vehicle accident or by a simple motion such as pulling bed covers over oneself. In athletics, a tear may occur by an overuse syndrome caused by throwing too many pitches, or excessive force placed against the shoulder in external rotation, as in football.

Symptoms include pain along the outside aspect of the shoulder more significant at night and with attempts at raising the arm. Patients show traditional weakness in elevating and externally rotating the arm. Plain x-ray examination can sometimes show degeneration along the attachment site of the specific muscle, the rotator cuff. Magnetic Resonance Imaging with intrarticular contrast can demonstrate tears in cases which are more difficult to diagnose.

Treatment is directed toward elimination of pain. Repair of the cuff back to its normal attachment and removal of any associated bone spurs results in an approximate 85% success rate in relieving of pain.

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