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Rotator Cuff Injury
Rotator Cuff
The glenohumeral joint is a ball-and-socket joint between the head of the humerus (the ball) which articulates with the glenoid cavity (the socket) of the lateral surface of the scapula.
The rotator cuff muscle tendons keep the head of the humerus attached to the scapula. These tendons form the helpful acronym: SITS
- Supraspinatus
- Infraspinatus
- Teres Minor
- Subscapularis
Classifications of Injury
- Subacromial Bursitis
- Rotator Cuff Tendinosis
- Rotator Cuff Tendon Tear (Complete vs Partial)
- Rotator Cuff Arthropathy
Subacromial Bursitis & Rotator Cuff Tendinosis
- Subacromial bursa inflammation presents in similar fashion to rotator cuff tendinosis (typically of supraspinatus).
- Presents with pain with overhead motion and pain awakening the individual from sleep.
- Typically normal range of motion (or slight limitation).
- No weakness or muscle atrophy.
- Positive impingement sign
- Pain with forward flexion with internal rotation "emptying a beer can".
- View this Rotator Cuff Impingement video from the British Journal of Sports Medicine.
- Treatment involves:
- Activity modification, physical therapy (PT), and NSAIDs (non-steroidal anti-inflammatories (eg, ibuprofen)).
- Subacromial corticosteroid injection, if necessary.
- Subacromial decompression (aka acromioplasty) is reserved for severe cases.
Rotator Cuff Tendon Tear
- Typically involves supraspinatus.
- Presents with pain with overhead motion and pain awakening the individual from sleep.
- Weakness occurs and there can be potential muscle atrophy.
- Range of motion is limited.
- Positive impingement sign.
- Tear can be partial or full-thickness - and tears can progress from partial to full.
- Treatment involves:
- Rest, physical therapy (PT) - range of motion exercises, and NSAIDs (non-steroidal anti-inflammatories (eg, ibuprofen)).
- Immediate repair if there is risk of tear progression.
- Severe tears can lead to arthropathy via abnormal contact between the humeral head and the glenoid.