The shoulder has the most mobility of any joint in the body. Even small injuries can result in significant loss of use of the shoulder. One of the most common injuries to the shoulder is the Rotator Cuff. The Rotator Cuff consists of 4 separate muscles and can be injured by overuse, repetitive smaller injuries, or a single larger injury. Most injuries will result in either weakness, stiffness, or instability of the joint. Because of the significant number of muscles around the joint, rehabilitation plays an extremely important role in getting back in the game. When surgery is needed to heal injury, minimally invasive techniques are utilized to reduce the length of disability and allow a faster return to activities.

AC Joint Injury (the separated shoulder)

The acromioclavicular (AC) joint is the meeting point of the acromion and clavicle bones in the shoulder area, often indicated with a visible bump in the area. AC joint injuries often occur as a result of a fall or other trauma, which may cause the acromion to move or separate from the clavicle, or cause the ligaments to be stretched or torn.

While conservative treatment is often used first for AC joint injuries, surgery may be required for injuries that are more severe or those that cause prolonged pain.

Labral Tear

A labrum is a protective cuff of cartilage found in ball and socket joints like the hip and shoulder. They provide more stability, cushioning and a full range of motion for these shallow joints. A tear in the labrum, known as a labral tear or Bankart tear, is caused by injury or overuse and can lead to pain and “catching” of the joint while moving. A dislocation of the shoulder is a common cause of labral tears and can result in the shoulder feeling unstable or sliding out of joint.

Treating a Shoulder Dislocation

After a shoulder dislocation, physical therapy is commonly used to help restore motion, reduce pain and regain strength. The labrum has a very poor ability to heal on its own. Labral repair surgery, or Arthroscopic Bankart Repair, aims to repair unstable shoulders with arthroscopic surgery.

What is a rotator cuff?

The rotator cuff is the thick band of muscles and tendons that covers the top of the upper arm and holds in its place, providing stability and a full range of motion to the shoulder joint. It is made of four muscles and their associated tendons. These tendons can become partially or completely torn as a result of a rotator cuff tear. A rotator cuff tear most often occurs as a result of overuse of the muscles over a long period of time. As a result, this condition is most common in patients over the age of 40. It may also occur as a result of a traumatic injury, and involves pain when lifting or lowering their arm, muscle weakness, and atrophy.

Rotator Cuff Repair

Many rotator cuff tears can be treated through nonsurgical methods that focus on relieving pain and restoring function to the shoulder. These may include:

  • Rest
  • Use of a sling
  • Anti-inflammatory medication
  • Steroid injections
  • Physical therapy

Surgery may be recommended for tears that cause severe pain or that do not respond to more conservative treatments. The type of surgery performed depends on the size and location of the tear, but often involves trimming torn edges or suturing the tendon back together.

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More Information

Rotator Cuff Injuries

Four muscles in the shoulder that when injured or damaged can lead to sleepless nights, pain, and weakness.

The most common ways of injury to the rotator cuff are trauma, such as a fall on the outstretched hand, repetitive overload to the tendon by activity, or bone spurs cutting into the tendon.

Symptoms commonly begin with pain over the upper arm that is worse with reaching overhead, lying on your side, reaching behind your back, and weakness.

The rotator cuff has a very limited capacity to heal on its own and therefore treatment is often required to improve symptoms. This usually begins with a short period of rest, followed by a rehabilitation program focused on mobility, and strength to improve function. Steroid injection can be used if significant inflammation is present and interferes with the ability to engage in the exercise program. Two thirds of patients will improve with these modalities alone, and thus this is the first phase of treatment.

If symptoms persist, MRI is utilized to evaluate the rotator cuff for tears. Most commonly injured is the supraspinatus tendon. This is the muscle that allows you to put on a jacket, reach into the kitchen cabinet and get out the dishes, put a gallon of milk in the refrigerator, or pour a pot of coffee. Because the tendon is spring loaded, full tears commonly separate or retract. The more the retraction, the more serious the tear. If these tears are not addressed, atrophy will ensue and the tears will frequently get larger over time.

Surgical repair is performed arthroscopically and consists of stretching the tendon back out to it’s attachment point and repairing it back to the humerus greater tuberosity that it pulled off from. Traditionally, the shoulder was immobilized in a sling for up to 6 weeks before starting physical therapy to protect the repair. The downside of this approach was a high rate of postop stiffness, called frozen shoulder. We pioneered an accelerated rehab program for rotator cuff 25 years ago that reduced this immobilization down to just 5 days and actually lowered to postop stiffness rate.

Quality of the rotator cuff tissue has been a major determinant of success of the surgery, as well as the recurrent tear rate. The larger the tear and degree of separation, the higher the recurrent tear rate – that can approach 50 percent!

Innovation in rotator cuff surgery revolves around the use of biologics to reduce the risk of recurrent tears. CuffMend is an acellular, dermal allograft that is placed upon the repair to effectively double the thickness of an atrophic tendon and reduce the risk of recurrent tears. We have been effectively utilizing this technology over the past 2 years with great success to enhance patient outcomes for the most serious tears.

We remain committed to utilizing the best technology to remain innovators in rotator cuff surgery.