Rotator Cuff Syndrome

What is it?

Your shoulder is a ball in a cup. Above the ball runs a tendon which helps lift the arm up. Above the tendon is a bony arch. You can feel this bony arch under the skin at the top of your shoulder.

How do you get it?

As you lift your arm up, the tendon has to slide in underneath the bony arch.  If the space is a bit too narrow, the tendon starts rubbing on the bony arch.  Once the tendon is rubbing on the bony arch, the space gradually gets even narrower.  This occurs slowly over many years.  Rubbing on the bony arch damages the tendon and eventually it will tear.  Once there is a large tear, which has retracted a long way, the shoulder joint itself wears out (develops osteoarthritis).    

What symptoms do you get?

Rotator cuff syndrome causes pain around the shoulder, typically with your arm half way up (about horizontal), but comfortable again once the arm gets into full elevation.  Once the tendon starts to tear, symptoms will become more severe.  If the whole tendon has torn off, you are unable to elevate your arm.  Once osteoarthritis has set in, there is pain with all movements.

What happens without treatment?

Typically, the pain will continue, slowly getting worse over time.  

How do you treat it?

Some patients will settle with a cortisone injection, but the most reliable treatment is to operate on the shoulder and remove some bone from the bony arch.  This gives the tendon more room and turns off the process.  If the tendon is torn, then it is repaired.  Once osteoarthritis has developed in the joint (rotator cuff arthropathy), a joint replacement may be the best option.