BACKGROUND: The rotator cuff consists of a group of muscles and tendons that surround the shoulder joint. They work together to stabilize and strengthen the shoulder.

A rotator cuff injury involves one or more of those muscles. It can be caused by a fall or be due to aggravation to the muscle over time. The injury can range from tendinitis -- inflammation of the muscle -- to a partial or complete tear.

Chronic tears are usually found in people who have occupations or play sports that involve excessive overhead use of the arm, such as with painters or baseball players. Acute tears happen when the arm is raised suddenly and powerfully against resistance, such as when trying to cushion a fall. Tendinitis occurs with age, as the muscle wears from repetitive trauma or because of everyday shoulder movement.

A physician will examine a patient to see what areas are tender and to look for a deformity. They will measure the shoulder's range of motion through different directions and will check arm strength. They may also look at the neck to rule out a pinched nerve or other conditions are the cause of the pain. A tear in the rotator cuff can be identified using X-rays, magnetic resonance imaging (MRI) or ultrasound.

TREATMENT: In many cases, nonsurgical treatment can relieve pain and improve shoulder function. These options can include rest of the shoulder, a sling, anti-inflammatory drugs, steroid injections or physical therapy.

Surgery may be necessary for individuals that are in extreme pain, experience weakness or are unable to use their shoulder and for who were not helped by nonsurgical treatment. The surgery that is performed depends on several factors, such as the size, shape and area of the tear. A trimming or smoothing procedure, called debridement, is performed for partial tears. Complete tears are repaired by stitching the divided tendon back together.

A NEW ROTATOR CUFF REPAIR: Roughly half of rotator cuff repairs are performed using the traditional "open" technique that involves making an incision through the shoulder muscles. Recently, surgeons have started doing the procedure using an arthroscopic fiber optic camera.

This technique involves a smaller incision but requires more skills on the surgeon's part. Spero Karas, M.D., an orthopaedic surgeon at Emory University School of Medicine in Atlanta, Ga., is performing a variation of the less invasive surgery.

He's performing a "double-row" arthroscopic repair, which secures the tendon to the bone in two areas as opposed to just one. According to Dr. Karas, it is superior to the original "single-row" repair and leads to better long-term outcomes. The operation takes just five minutes to complete.

PREVENTION: For those who have had a rotator cuff injury in the past or for those at risk of getting one because of their profession, shoulder stretches or a strengthening routine can help. The Mayo Clinic recommends the following:

Do regular shoulder exercises.

If in a profession that requires repetitive arm and shoulder movements, take breaks frequently.

When playing a sport that requires repetitive arm use, rest your shoulder regularly.

Use cold packs and heat pads when you experience any shoulder pain or inflammation.

FOR MORE INFORMATION, PLEASE CONTACT:
Spero Karas, M.D.
(404) 778-7204
www.atlantashoulder.com
www.emoryhealthcare.org/departments/sports/index.html