By: Gerald Weniger, MEd, MPAS, ATC, PA-C

It doesn’t matter if you are a professional athlete or a weekend warrior, shoulder injuries are bound to happen – both acute and overuse. Common acute injuries of the shoulder include acromioclavicular joint separations, glenohumeral dislocations, clavicle fractures, and labral tears. But what about rotator cuff tears? Injury to the rotator cuff is the single most common problem that affects the shoulder1. It accounts for about 4.5 million medical encounters per year1.


What is the rotator cuff exactly? In my years of orthopedic practice, I’ve heard patients commonly (and incorrectly) refer to it as the “rotor cup”, and I can’t help but chuckle. The “cuff” part is comprised of the adjacent four tendons of the following muscles: the subscapularis, supraspinatus, infraspinatus, and teres minor. Each muscle acting individually causes a particular movement of the humerus at the glenohumeral joint. But together, the four tendons that make up the cuff also act as dynamic stabilizers to keep the humeral head in anatomic position. This is necessary because the glenohumeral joint has far less static stabilization (in the form of ligaments and joint surface) than a similar ball and socket joints like the hip.


Much of the general public hears the word “tear” and automatically assumes that rotator cuff tears can only be the result of a single traumatic injury. But this is incorrect. Although possible to occur acutely from a fall, rotator cuff tears are far more likely to happen as the result of chronic overuse. Anyone with an occupation that involves working overhead is susceptible. Think of the rotator cuff as being like a piece of fabric. Sure it can be torn in a single movement, but it can also slowly fray and wear away over time, especially when something is rubbing over it consistently. In the case of rotator cuff tears, the uppermost part of the cuff can rub on the undersurface of your acromion, causing eventual fraying. The subacromial bursa is there to try to mitigate this, but often this bursa can become chronically angry and inflamed – making the problem worse. This pinching of the top of the rotator cuff is called “impingement.” Neer has reported that impingement precedes 95% of chronic rotator cuff tears2.


Partial-thickness tears often respond well to conservative management, such as physical therapy. Full-thickness tears typically need surgical repair in the end. Augmenting the surgical repair with “orthobiologics” such as platelet-rich plasma, bone marrow concentrate, dermal allograft, or collagen patches, is not yet the standard of care. But these orthobiologic options are emerging as an exciting treatment option for the future. If you would like to learn more about the shoulder – especially how to properly evaluate a patient who presents with shoulder pain, then please join us for the Skin, Bones, Hearts, and Private Parts 2020 Conferences in Virginia Beach, Pensacola Beach, and Las Vegas!

References
Oh, L.S., Wolf, B.R., Hall, M.P., Levy, B.A., & Marx, R.G.. (2007). Indications for rotator cuff repair: a systematic review. Clinical Orthopedic Related Research. 455:52-63.
Neer III, C.E. (1983). Impingement lesions. Clinical Orthopedics. 173:70-77.

See Gerald Weniger, MEd, MPAS, ATC, PA-C speak at a Skin, Bones, Hearts & Private Parts event in 2020 – Virginia Beach • Pensacola Beach • Las Vegas