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Rotator Cuff Dysfunction

What is the rotator cuff and rotator cuff pathology?


Providing strength and stability, the rotator cuff is a group of four muscles and tendons that surround the shoulder joint.  Above the rotator cuff, there is a "bursa", or sac of tissue.  This tissue covers and protects the rotator cuff as it comes into close contact with bones around the shoulder.  If the rotator cuff is injured or damaged, it can lead to inflammation of the bursa, causing pain and loss of motion. 


Thickening of the rotator cuff and its bursa can lead to an impingement syndrome where these tissues impinge against the bones around the shoulder.  This can cause pain and damage to the rotator cuff.  Some rotator cuff injuries do occur in younger people secondary to trauma.  However, most injuries result from aging and degeneration of the cuff.  Damage to the rotator cuff can vary from microscopic tears to large irreparable tears. Symptoms include:


  • pain

  • weakness

  • restricted motion

  • catching

  • locking

  • a feeling of instability 


Rotator cuff pathology ranges from a normal, asymptomatic aging process to endstage arthritis and instability, caused by the absence of the rotator cuff.



Signs and Symptoms



Tears in the rotator cuff  increase in incidence with age.  However, not all rotator cuff tears are painful.  In fact, many individuals with rotator cuff pathology are completely asymptomatic.  When it does become symptomatic, it can be present in a variety of ways ranging from minor problems to servere pain and limitation of function. 


The onset of symptoms can be related to simple, ordinary activities of daily living.  Or, they can be attributed to a single event.  The symptoms are usually aggravated in certain positions, such as reaching backward to fasten a seat belt or picking up a briefcase out of the back seat.  Symptoms are worse when the arm is elevated overhead.   This is especially true if the elevated arm is loaded, such as picking up a stack of dishes out of an high cupboard or retrieving luggage from an overhead compartment.  Other overhead activities, such as pitching, throwing, or racquet sports, also commonly worsen the symptoms.

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