The shoulder joint is classified as a ball and socket joint, with the head of the humerus (long bone of the arm) being the ball and the glenoid cavity (indentation on the shoulder blade) being the socket. However the “socket” that the “ball” resides within is very shallow, often compared to a golf ball sitting on a tee, unlike the hip which gains its stability from the deep placement of the head of the femur into the pelvis, and this is often compared to a baseball in a glove. The rotator cuff consist of four muscles: supraspinatus, infraspinatus, teres minor, and subscapularis. These muscles not only aid in the minor movements of the shoulder, but they also provide the majority of the dynamic stability at the joint. They hold the head of the humerus tightly into the glenoid cavity, in a way that is analogous to a racing harness keeping a racecar driver tightly into their seat. With this lack of boney stability, the shoulder joint gains a wide range of mobility, which allows it to function in a variety of movements such as throwing a ball, lifting an object above ones head, etc. Yet, with the inherent mobility, comes an increased risk of injury and instability.
One of the most common shoulder injuries is a rotator cuff tear. This typically occurs in two main ways:
- The first way this can happen is through the years of repetitive use and repetitive strain on the rotatory cuff resulting in the wearing out and weakening of the rotator cuffs muscles and tendons, ultimately resulting in it just tearing. When this happens it is not uncommon that the individual does not realize when the complete tear actually occurs.
- The second mechanism is in a single traumatic incident such as a fall onto the shoulder or arm or sudden jerking motion. A tear will result in decreased stability at the joint, which if left untreated, can cause further damage to the joint, such as labral tears or arthritis.
Tears will normally manifest with pain onset by any overhead activities, pain at night, weakness, and even decreased range of motion. Upon history and physical exam by a physician, there will be decreased strength and/or pain with movements, this coupled with a detailed history of the onset of the problem will allow the physician to become fairly certain as to what injury has occurred. The physician may opt to have imaging studies conducted, such as X-Ray, MRI, or Ultrasound, to gain a better understating of the particular injury at hand and rule out any other more ominous conditions.
Treatment of rotator cuff tears is largely dependent upon the age and activity level of the patient, mechanism of injury, and the character of the injury (partial tear vs. complete tear). If conservative treatment is opted for, it is likely that physical therapy in conjunction with icing, rest, NSAIDs and possibly corticosteroid joint injections will be used to aid in the natural healing process of the body. If a more aggressive treatment method is needed, it is likely that surgery will be used to correct the problem at the source. Rotator cuff repairs are typically done arthroscopically (surgical scope). Surgical intervention and conservative methods of treatment is something that you should discuss with your physician in order to determine how to best manage your specific injury
If you are experiencing any of these symptoms, consult one of our orthopedic shoulder specialists today!