Month: April 2011

The last blog dealt with understanding what the rotator cuff is and basically an overview about rotator cuff.

 How do I know if I have rotator cuff problems?

Contrary to popular belief, history and physical examination is still an incredibly accurate way to diagnose whether you have a rotator cuff problem.  An MRI is not always necessary.  If you have rotator cuff disease, you will have pain during or after an activity.  It will usually be located on the side of your shoulder and occasionally radiates down towards your elbow, but not below it.  Sometimes it will go up towards your neck, but that is usually if it is more severe.  If you have pain which wakens you from a sound sleep, it is much more likely you have a complete full-thickness tear.  Weakness with reaching and overhead work is also a sign of a partial or complete tear. 

Initial treatment of rotator cuff problems, in the acute setting can be use of ice 2-3 times a day and be really careful about your posture, keeping your shoulder blades back and down, and Aleve or Advil on routine schedule for several days, 5-7 days.  These are things that you can do to help at home, but if the pain does not get better, and you need to finally go to the doctor, some of the preliminary treatments have already been done.

Now that you have figured your rotator cuff problem, what is the next step?

As I mentioned, history and physical examination are still the gold standard and are amazingly accurate if done thoroughly for diagnosing rotator cuff pathology. I will next do an office ultrasound to examine the rotator cuff, which is convenient, accurate and less expensive than an MRI. You also do not have to go into a closed tube!

 I personally believe that MRI should be done if:

1.       I cannot figure out what is going on in my history and physical.

2.       If I am considering surgery on a patient, then it will help you in the decision making process.

3.       If there has been 6 weeks of treatment and the pain continues

4.       The ultrasound suggests a tear.

There are lots of variations in the quality of MRI scans as well as those reading them.  Closed MRIs are far superior to open MRIs in terms of quality and accuracy.  If you are claustrophobic, then Valium can also be given before the test to sedate you.  If that is not useful, then we will obtain an open MRI or a test called CT arthrogram could be done.  If it is positive, then the next step will be to discuss surgical options.

– Lesley J. Anderson, MD

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

http://online.wsj.com/article/SB10001424052748703905404576164251084032340.html