Rotator Cuff Injuries

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An Overview of Rotator Cuff Injuries

The rotator cuff, located within the shoulder, is made up of tendons and muscles. These shoulder elements connect the upper arm bone with the shoulder blade and they are in place to help hold the ball of the upper arm bone firmly to the shoulder socket.  All of these biological functions come together to create the greatest range of motion of any joint in the human body.

Rotator cuff injuries are very common.  They can occur when any irritation or damage affect the rotator cuff muscles or tendons. Many activities can lead to this type of injury including falling, lifting, repetitive overhead arm activities and degeneration of the rotator cuff tendon. The incidence of rotator cuff damage increases with age.

There are 3 distinct rotator cuff injuries:

Tendinitis occurs when the rotator cuff tendons become inflamed due to overuse or overload. Athletes will often find themselves with this condition if they are involved in daily or routine overhead sports such as tennis or basketball.  Bursitis is an inflammation that occurs when the fluid-filled sac (bursa) between your shoulder joint and rotator cuff tendons become irritated. This can also be a cause of overhead activity or overuse of the shoulder muscle.  If the first two conditions are not dealt with, a person could experience a strain or tear in the rotator cuff region, which will require a more drastic treatment approach.

Rotator Cuff Tear Patterns Video

Symptoms of Rotator Cuff Injuries

The most common symptoms associated with a rotator cuff injury are sharp shoulder pain and shoulder tenderness.  Everyday activities such as scratching your head, putting on a shirt, laying down on the affected side and carrying a moderately light object will create pain over regular use of the arm.  There will be an overall weakness in your arm and this weakness and pain will create anxiety that will prompt you to keep our shoulder inactive.

Rotator Cuff Tear & Repair Images

(Click to Enlarge Image) Both arthroscopic images show another type of double-row repair (SpeedBridge or knotless double-row repair) of a torn supraspinatus tendon.

(Click to Enlarge Image) The top left arthroscopic image shows a large crescent tear of the supraspinatus tendon. The top right arthroscopic image shows the tear being mobilized. The bottom left arthroscopic image shows the final double-row suture bridge repair of the torn supraspiantus tendon. The bottom right arthroscopic image is another view of the final repair.

(Click to Enlarge Image) Before (left) and after (right) arthroscopic images showing an acromioplasty procedure in which bone from the undersurface of the acromion is removed to allow the rotator cuff tendons to pass smoothly underneath.

Have you experienced a rotator cuff injury?

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You can provide current X-rays and/or MRIs for a clinical case review ($150).

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Treatment of Rotator Cuff Injuries


Rotator cuff injuries are very common problems and can many times be healed without treatment.  If a patient has a mild rotator cuff injury, it is important to keep the hurt shoulder inactive with plenty of rest.  Apply ice daily and use an anti-inflammatory medicine to help with any swelling and pain.

If the shoulder does require surgery, minimally-invasive arthroscopic surgery can usually repair the milder degree rotator cuff injury. In the event arthroscopic surgery does not work or is not recommended due to a more severe rotator cuff injury, there are other options that will treat the condition.


‘Double-Row’ Arthroscopic Rotator Cuff Repair

For patients who have significant injuries to the rotator cuff, or who are experiencing recurrent shoulder problems and defects after open and/or arthroscopic surgery has been performed, a double-row arthroscopic rotator cuff repair might be recommended. The double-row arthroscopic repair technique typically improves the overall quality of the rotator cuff restoration process. ‘Double row’ refers to the way the tendons are repaired—with a double row of sutures rather than just a single row.

Rotator Cuff Repair Video

Rotator Cuff ‘Healing Response’ Technique

The rotator cuff healing response technique is a novel procedure that uses the body’s own stem cells and bone marrow to help repair damaged rotator cuff tendons. This arthroscopic procedure involves making tiny “microfracture” holes in the bone; the blood clot from the bone that releases blood captures the end of the injured muscle and eventually reattaches the ligament back to the bone. No sutures are needed with this repair technique so patients have rapid recoveries.

Tendon Transfer for Failed Rotator Cuff Repair

Sometimes, open or arthroscopic rotator cuff surgery fails to work. In a massive rotator cuff tear good results can occur through a tendon transfer. A tendon transfer is a surgical procedure by which a tendon and its muscle are moved from one location to another. This procedure is completed so that lost function of the shoulder can be regained.  This procedure requires technical skill from the surgeon and is more of an undertaking than basic rotator cuff repair surgeries; it is often a last step or salvage surgery.

For additional information on rotator cuff injuries, please contact the orthopedic practice of Dr. Peter Millett.

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