The Rotator Cuff of the Shoulder
The shoulder is the most mobile and dynamic joint in the body. Its extensive ROM is due to its stability being primarily dependent on soft tissue structures rather than boney constraint. Four of these soft tissue structures are the rotator cuff muscles. These muscle tendon units blend together to form a musculo-tendonous cap over the top of the arm bone, know as the humeral head. Their function is to aid in humeral head depression, stabilization and movement of the arm in space.
Loss of the integrity of the rotator cuff, i.e. a tear, is a common cause of shoulder weakness and pain. The patient with a rotator cuff injury may have difficulty raising their affected arm, rotating it out to the side or in towards the body, due to weakness and/or pain. Normally for the rotator cuff to become injured, the shoulder must sustain a single, major force, as seen with a traumatic injury or repetitive smaller forces over time. Once weakened, the injured cuff tissue can sustain further injury simply with activities of daily living thus leading to further functional loss.
When rotator cuff tears are relatively new, so called acute tears, the chances of regaining shoulder strength while eliminating shoulder pain with rotator cuff surgery are very good. Conversely, when the defect or injury is long-standing and due to chronic, repetitive activities, the so called degenerative tear, the quality and quantity of tissue available for repair may not be sufficient for complete restoration of normal shoulder function. None the less academic studies have shown that some restoration of cuff integrity leads to excellent pain relief and improved function in many patients while avoiding or delaying the sequelae of severe shoulder arthritis and shoulder replacement surgery.
The immediate goals of rotator cuff surgery are to relieve pain, restore movement and improve overall shoulder function, with the ultimate goal being a full return to activities. Whether or not this is achieved depends on many patient factors including the duration of symptoms, tear size, tissue quality, and patient health and lifestyle.
Regardless of final treatment choice a good early evaluation by your Orthopaedic surgeon and an initiation of a physical therapy program with cuff protective and restorative exercises is highly recommended in order to maintain a full range of motion.