Rotator Cuff (cont.)
How is rotator cuff disease diagnosed?
Rotator cuff disease is suggested by the patient's history of
activities and symptoms of pain in the shoulder described above. In
making a diagnosis, the doctor can observe increased pain with
maneuvers of the shoulder. The pain is due to local inflammation and
swelling in the injured tendons of the rotator cuff. Additionally, with severe tendon
tears of the rotator cuff, the arm falls due to weakness (positive
drop sign) when moved away from the body.
The diagnosis of rotator cuff disease can be objectively
confirmed by radiology testing. Sometimes plain x-rays can show bony injuries
which suggest long-standing severe rotator cuff disease when it has been present
for some time. An arthrogram involves injecting contrast dye into the shoulder
joint to detect leakage out of the injured rotator cuff. The MRI is a noninvasive imaging test which uses a
giant magnet and computer to produce fine images of the tissues of
the shoulder. An MRI has the added advantage of providing more
information than either X-ray or an arthrogram, especially if a
condition other than rotator cuff disease is present.
How is rotator cuff disease treated?
The treatment of rotator cuff disease depends on the severity of the
injury to the tendons of the rotator cuff and the underlying
condition of the patient.
Mild rotator cuff disease is treated with ice, rest, and antiinflammatory medications (such as ibuprofen and others). Generally,
a gradual exercise rehabilitation is instituted. Exercises are used
that are specifically designed for rotator-cuff strengthening.
Patients with persistent pain and motion limitation can often benefit
by a cortisone injection in the rotator cuff. Sometimes, repeat
injections are necessary.
More severe rotator cuff disease can require surgical repair.
Subacromial decompression is the removal of a small portion of the
bone (acromion) that overlies the rotator cuff. This removal can
relieve pressure on the rotator cuff in certain conditions and
promote healing and recovery. This procedure can be done by
arthroscopic or open surgical techniques. Both methods have been
reported to be equally successful.
The most severe rotator cuff disease, complete full-thickness rotator
cuff tears, usually requires surgical procedures for the best
results. These procedures, which can also be done by either
arthroscopy or open surgery, involve mending the torn rotator cuff
by suturing the tissues back together.
Next: What is the outlook (prognosis) for rotator cuff disease? »
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