Rotator Cuff Pathology

Rotator cuff injury is a condition that is caused by damage to a group of four muscles-tendons that is commonly referred to as the “rotator cuff.” These muscles and tendons provide strength and stability to the shoulder joint, supporting overhead and other arm motions necessary to perform daily tasks and activities. Dr. Chahla is a sports medicine trained orthopaedic surgeon serving the Chicago, Oak Brook, Naperville, Illinois as well as Munster, Indiana areas, who specializes in the diagnosis and treatment of this condition.

Rotator cuff injuries occur when any of the four muscle-tendon groups become damaged due to chronic overuse or acute injury. Damage to the rotator cuff often is described as “tearing” or separation of the muscle-tendons from their attachment sites in the shoulder joint. This often can be accompanied by decreased mobility and severe pain.

What are the symptoms of rotator cuff injuries?

Symptoms commonly accompanying rotator cuff injury include shoulder pain and tenderness over the lateral (outside) part of the arm, which may radiate (move to) the elbow and worsen at night. These symptoms occur due to inflammation in the shoulder joint stemming from a torn rotator cuff. Certain activities, such as lying on the injured shoulder, carrying an object, or simply lifting the affected arm, can increase pain. Weakness is also common and does not allow patients to perform certain activities. Some patients will complain of inability to sleep on that side.

Who gets rotator cuff injuries?

Risk of rotator cuff injuries increase as we age, and most commonly occur in people older than 40 years of age. In addition, athletes who compete in certain sports with repetitive overhead arm motions, such as baseball pitchers, tennis players and swimmers, are more likely to develop a rotator cuff injury.

What causes rotator cuff injuries?

There are various potential causes of rotator cuff injuries, including:

1. Acute injury – injuries that are acute in nature can occur as a consequence of an injury during a sport, fall, or traumatic incident (such as a motor vehicle accident). Following these injuries, you will notice an immediate onset of pain and loss of function.
2. Chronic overuse – this can occur due to long-term, repetitive motions that damage the rotator cuff tendons. Examples of this include certain sports activities, such as baseball pitching, tennis and swimming, or work-related activities such as lifting heavy objects.
3. Degeneration – Degeneration and tears of the rotator cuff tendons can occur as we age. This is a natural consequence of the process of normal wear and tear.

How are rotator cuff injuries diagnosed?

The diagnosis of rotator cuff injury is based off of findings on both clinical examination and various imaging techniques. Dr. Chahla will first conduct a thorough examination of the affected shoulder, specifically to identify any physical deformities, abnormal weakness, or muscle wasting. He also will assess passive and active range of motion as well as strength of the affected shoulder. Special physical examination tests can help determine which parts of the rotator cuff are affected as well as the severity of the injury.

If necessary, muscle and tendon damage can be further examined through multiple imaging techniques, including X-rays and magnetic resonance imaging (MRI) of the affected shoulder.

How do you treat rotator cuff injuries?

Rotator cuff injuries do not always require surgical treatment. Various factors including the patient’s level of physical activity, type of rotator cuff injury, and tear size influence the success of non-surgical options. Non-surgical treatment often involves rest, ice and heat, physical therapy, and the use of medications and cortisone injections to provide pain relief and improved physical function.

If non-surgical treatment options do not effectively decrease symptoms, surgical options are available to repair the tear. The benefits and likely outcomes of these procedures will be thoroughly presented by Dr. Chahla and discussed with each patient. Arthroscopic rotator cuff repair is a commonly used surgical procedure that is minimally invasive. This surgery entails repairing the torn rotator cuff with the help of a small camera. The camera is inserted through a series of small incisions in the shoulder allowing for the damaged area to be viewed by Dr. Chahla on a large television screen. This larger view allows Dr. Chahla to insert several small instruments into the shoulder joint and repair the injury. Arthroscopic surgery is advantageous due to reduced pain and quicker return to sports and activity following surgery.

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