The rotator cuff is responsible for most of the movement and power in the shoulder. Pushing, pulling, and especially overhead reach put a lot of stress on the rotator cuff.
Rotator Cuff Tear
Inflammation of the rotator cuff will cause pain and weakness with these movements. Another cause can be a rotator cuff tear. Distinguishing simple inflammation from a tear is not always obvious. There are some tests that a physician can perform that may help distinguish a tear from simple inflammation, but none of these is 100% accurate. In general, the more severe the symptoms—pain, weakness, stiffness—the more likely there is a tear.
Rotator Cuff Treatment
There are non-surgical and surgical treatment options for any rotator cuff problem—inflammation or a tear. Usually the first step in treating a rotator cuff problem is simply oral anti-inflammatory medication. Physical therapy is also often recommended to restore movement and strength in the shoulder. This can sometimes be very effective in reducing shoulder pain and improving function. If oral medication or physical therapy are not helping, a cortisone injection in the shoulder is often the next option.
If oral medication, physical therapy, and cortisone injections do not provide relief, an MRI of the shoulder may help determine the underlying cause of the continued pain. X-rays are very helpful for evaluating bones and joints, but soft things, like tendons, are not visible on X-rays. An MRI allows the tendons, ligaments, and cartilage to be directly seen and evaluated. With a tear, a hole or gap is often visible on the MRI.
This gap in the tendon is not generally capable of spontaneous healing. Most rotator cuff tears require surgery in order to heal. Small tears can sometimes be managed without surgery, but the tear does not heal; it simply stops hurting.
Rotator Cuff Surgery
Surgery to repair a torn rotator cuff is often done with a specialized camera, an arthroscope, that allows small incisions around the shoulder. The camera is inserted and used to evaluate the shoulder. Additional small incisions are then made, and specialized tools are used to perform the surgical repair inside the shoulder. The repair consists of re-attaching the torn tendon back to the bone. Arthroscopic repair avoids large incisions and is often much less painful than open surgery. Less muscle damage allows a more rapid recovery and return to physical activity. Very large tears may be too difficult to repair with arthroscopic surgery and may require an open surgery to satisfactorily repair the damaged tendon.