The rotator cuff is a group of four muscles and tendons that originate on the scapula and attach distally on the tuberosities of the humerus (the long, upper arm bone). These muscles provide stability by acting as a cuff around the joint, keeping the humeral head centrally located in the glenoid fossa. The rotator cuff is also essential in moving the arm, allowing the arm to be raised overhead in front and to the side of the body.
Tears of the rotator cuff occur in several varieties, including partial thickness and full thickness tears. In most cases, the tear is in the tendon which attaches the rotator cuff muscles to the humerus bony tuberosities. Tears may result from acute trauma such as falling, lifting, repetitive overhead arm activity or gradual degeneration of the rotator cuff tendon.
Additionally, irritation of the small, fluid-filled sac located above the tendinous insertions of the rotator cuff muscles, known as the bursa may cause inflammation (known as bursitis). Symptoms of a rotator cuff injury include pain and tenderness in the shoulder, especially when reaching overhead, or behind one's back, or sleeping on the affected shoulder. Night pain is a common symptom, which may wake one up from sleep. A person with a torn rotator cuff may experience weakness, and may be unable to lift their arm against even minimal resistance.
Treatment for rotator cuff injuries varies depending on the severity of the injury. Partial tears, tendonitis (inflammation of the tendon) and bursitis are often treated conservatively through the use of physical therapy, rest, ice, anti-inflammatories and, if necessary, steroid injections.
Surgery is often recommended for full-thickness tears or for partial thickness tears which fail to improve with conservative measures. If surgery is required, minimally invasive arthroscopic surgery may be used to repair most tears.
In arthroscopic rotator cuff repair, the torn tendon is sewn back to the bone of the humerus. Dr. Domb continues to research the most advantageous methods of repair, and his evolving innovations have been published in the Journal of Bone and Joint Surgery, the most prestigious journal in Orthopedic Surgery.
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Recovery
Shoulder arthroscopy is generally an outpatient procedure. The average postoperative course involves 2-6 weeks in a shoulder sling to protect the work done on the shoulder. A sling may be required for 6 weeks if the shoulder's condition requires a more extensive surgery. Most patients begin physical therapy 2-6 weeks after surgery. Patient's return to work is extremely variable after their procedure, depending on their surgery and their work type. Athletes can expect to return to sports between 6 months and 1 year after surgery. High-level athletes participate in an intense physical therapy course after surgery, gradually increasing their workout intensity.
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