There was a pretty good article in the Wall Street Journal a few weeks back on rotator cuff tears by Laura Londro. I thought I will explain the next couple of blogs on rotator cuff injuries/problems. The rotator cuffs are a group of four muscles that come off the shoulder blade or scapula and attach to our humerus/arm and allow us to lift our arm up overhead. A vast majority of problems occur in the supraspinatus because the blood supply to this particular tendon is the most at risk when you lift your arm away from your body. The rotator cuff has to glide under the bony archway, the acromion, when you lift your arm to the front and to the side. Any problems with the attachment of the rotator cuff to the bone can cause pain.
The rotator cuff will start to degenerate as early as our 20s where pain that develops at that point in time is mostly related to overuse, an aggressive game of tennis, and is rarely seen as a primary problem in someone less than 30. Shoulder pain in someone under 30 with the diagnosis of rotator cuff is usually due to another cause such as an unstable shoulder with the rotator cuff becoming secondarily inflamed.
Between 30 and 50, the rotator cuff becomes more degenerated mere replacing the word “tendonitis” (which means inflammation with tendinopathy) which means more related to degeneration. Over the age of 50, the rotator cuff will further degenerate at a normal process of aging and either develop partial tear which can be small or complete. Therefore, the cause of rotator cuff problems only depends on one’s age. Under 30, look at your technique of performing your sporting activities, make sure the diagnosis is correct as instability is also in the cause of “rotator cuff problems under 30.” Between 30 and 50, the cause of rotator cuff problems is usually due to weakness of the scapular muscles and this is an age group where the training technique, physical therapy, and conservative treatment can often be very valuable.
Over 50 and only can the rotator cuff be a source of pain but there are other areas that could be the source of pain including the cervical spine, arthritis in the shoulder joint or in the AC joint. So careful physical examination is important. Other causes of pain between 30 and 50 are calcium deposits and bone spurs that can cause mechanical pinching of the rotator cuff also which can be treated successfully surgically to prevent progression to cuff repairs.
The next blog will involve discussing how you know if you have a rotator cuff problem. Then we will discuss the various treatments nonsurgical and finally the surgical treatments of rotator cuff problems.
- Lesley J. Anderson, MD