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Rotator Cuff Injuries

The Shoulder or Glenohumeral joint is stabilized by a group of muscles called the rotator cuff. These are the Supraspinatus, Infraspinatus, Subscapularis and Teres Minor. They arise from the scapula and merge to form the rotator cuff tendon, which is inserted into the greater and lesser tubercles of the humerus. Their tendons hold the head of the humerus in place in the concave glenoid fossa of the scapula.

The muscles and their tendon work together to reinforce strength in all directions of the shoulder and arm, and allow for movements like raising your hands, jumping jacks, and even giving hugs.

Supraspinatus abducts the humerus, Infraspinatus and Teres Minor externally rotate the humerus, while Subscapularis internally rotates it. The most commonly injured of these is the supraspinatus muscle.

The tendons are susceptible to tears, impingement and inflammation. When damage occurs to the muscle, it cannot effectively stabilise the shoulder. A patient would usually present with pain and weakness of the joint. In a clinic this can be diagnosed by a positive painful arc test, the drop arm test and weakness in external rotation; and radiologically with x rays, musculoskeletal ultrasounds and MRIs.

Rotator cuff tears can be managed with physical therapy, steroid injections, topical agents, massage and acupuncture; but if the trauma is severe, then surgical treatment is required.

Fortunately, this treatment is minimally invasive and can be done arthroscopically with small incisions, fine instruments and cameras. This procedure is often done as an outpatient procedure, which does not require hospital stay.

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