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Specialties: Arthroscopic Rotator Cuff Repair Symptoms and Diagnosiss

Tendonitis

People with rotator cuff tendonitis typically complain of shoulder pain at the tip of the shoulder and the upper, outer arm. Specialists often refer to tendonitis as tendinopathy because there is no evidence of inflammation with this injury. The pain is often aggravated by reaching, pushing, pulling, lifting, positioning the arm above the shoulder level, or lying on the side. Painful daily activities may also include putting on a shirt or brushing hair. The pain may prevent comfortable sleep, or awaken a person from sleep, particularly if he or she sleeps on or rolls onto the shoulder.

Tear

Symptoms of rotator cuff tear often include pain and weakness of the shoulder, although some people have few or no symptoms. In addition, the severity of the tear does not necessarily correlate with the severity of a person's pain; in other words, a person with a partial tear may have severe pain while a person with a complete tear may have little or no pain.

Diagnosis

The diagnosis of rotator cuff tendonitis or tear is usually based upon the person's symptoms and a physical examination. The provider will examine the shoulder to determine which areas are painful or tender. He or she will assesses how movement of the shoulder and arm affect pain and muscle strength.

To differentiate rotator cuff tendonitis from tear, the healthcare provider may inject the shoulder joint with a local anesthetic. In people with tendinopathy, the anesthetic will relieve pain and the muscle strength is usually normal. In people with a tear, the anesthetic will relieve the pain, although the muscles are usually weak.

In most cases, x-rays and other imaging tests are not needed to diagnose tendinopathy. However, if the person's symptoms do not improve after a course of conservative treatment, an imaging test (eg, x-ray, ultrasound, and/or MRI) may be recommended to confirm the diagnosis.

If a rotator cuff tear is suspected, an imaging test (ultrasound or MRI) is usually recommended to confirm the tear. Initially, smaller tears are treated conservatively, with rest, ice, stretching, and strengthening exercises. If the pain or weakness fails to improve or if a large tear is confirmed with an imaging test, most people are referred to a specialist (orthopedic surgeon) for further evaluation and management.

The surgical procedure is used to inspect and reattach torn tendons in the shoulders’s rotator cuff. The initial part of the surgery is performed arthroscopically through small tubes. In some cases, open surgery may be needed to repair large tears.

The surgeon inserts a small video camera called an arthroscope through tiny incisions in the shoulder to inspect the damaged joint.

The surgeon then removes any loose fragments of tendon or debris for the damaged cuff tendons in the joint. This procedure, call a debridement, is usually performed arthroscopically. Afterwards, the surgeon inspects the tissue damage in the joint and determines if more surgery is needed.

If bone spurs have formed on the bottom of the acromion, the surgeon uses a rasp-like tool to smooth is area. Occasionally this area will be further smooth out by using a special instrument call an arthrocare. This keeps the acromion from pinching down on the Supraspinatus tendon.

The surgeon uses a drill or sharp tool to create one or more small holes in the bone. The anchors are then placed into the holes. The anchors hold stitches in place on the shoulder bone (humerus).

The tear in the tendon is stitched together. The sutures are pulled tightly against the anchors, reattaching the tendon to the humerus.

After the surgery, the arm is placed in a sling. Physical therapy will be needed to regain full range of motion and increased shoulder strength. Over time, the tendon will naturally reattach itself to the humerus bone.

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Last Modified: June 24, 2014