The rotator tendons attach to the upper end of the humerus and help to rotate the humerus in the shoulder socket (glenoid) as well as to pull the humeral head down as the deltoid muscle pulls the humerus up. Tears of the tendons, particularly of the supraspinatus tendon, can be caused by injury to shoulder and/or the gradual degeneration of the tendons from pressure and friction caused by the overlying acromion process.

Symptoms of Rotator Cuff Tears

• Weakness and pain, particularly, at night–time.
• Shoulder elevation.

Diagnosis of Rotator Cuff Tears

• Physical examination.
• Arthrogram (an x–ray in which dye is injected into the shoulder to see if a leak is present).
• MRI (magnetic resonance imaging).
• Arthroscopy.

Treatment of Rotator Cuff Tears
In active patients, they should consist of early surgical repair of the tendons, if the tear has been present for too long, repair may not be possible. Arthroscopy may be useful in decreasing the size of the incision needed for repair and, in older, less active patients, in relieving pain by opening up the space under the acromion (acromioplasty), taking the pressure off the torn tendon without repair of the tendons.

Convalescence following rotator cuff repair requires time to allow the tendons to heal, followed by protected motion to decrease the troublesome stiffness which frequently occurs, and, finally, muscular strengthening to increase function and to protect the repaired tendons.

Shoulder Arthroscopy
Diagnosis and treatment of shoulder problems is frequently done by arthroscopic, rather than by open surgical means. An arthroscope can be utilized to most of the shoulder structures through small incisions, and, similarly, additional small incisions can be utilized to introduce instruments to perform surgical procedures. The advantages of doing these procedures arthroscopically include smaller incisions, less pain, and, ideally, a shorter recovery period and earlier initiation of rehabilitation.

Procedures which lend themselves to arthroscopic surgery include arthroscopic acromioplasty, release of tight ligaments for frozen shoulder, and, some feel, shoulder reconstruction for dislocation or for rotator cuff repair. Many feel that the latter two procedures are not good indications, since the recovery period is not significantly shortened at the risk of a lower success rate.

Total Shoulder Replacement
When the cartilage surface, the humeral head and the glenoid socket become worn due to degenerative arthritis, rheumatoid arthritis, or post–traumatic arthritis, the shoulder can become stiff and/or painful. Properly taken x–rays will confirm the diagnosis.

Treatment consists of anti–inflammatory medications, such as aspirin, ibuprofen, etc., initially. If that is not effective, replacement of the shoulder joint with a prosthesis which substitutes for the humeral head (hemi replacement) or for the humeral head and glenoid socket (total shoulder replacement) can be done. This operation is usually effective in reducing or eliminating pain, and often improving motion.