Definition of Rotator cuff problems:

The rotator cuff is a group of muscles and tendons that attach to the bones of the shoulder joint, allowing the shoulder to move and keeping it stable.

• Rotator cuff tendinitis refers to irritation of these tendons and inflammation of the bursa (a normally smooth layer) lining these tendons.
• A rotator cuff tear occurs when one of the tendons is torn from overuse or injury.

Causes, incidence, and risk factors:

The shoulder joint is a ball and socket type joint where the top part of the arm bone (humerus) forms a joint with the shoulder blade (scapula). The rotator cuff holds the head of the humerus into the scapula and controls movement of the shoulder joint.

The tendons of the rotator cuff pass underneath a bony area on their way to attaching the top part of the arm bone. When these tendons become inflamed, they can become more frayed over this area during shoulder movements. Sometimes, a bone spur may narrow the space even more.

This problem is called rotator cuff tendinitis, or impingement syndrome, and may be due to:

• Keeping the arm in the same position for long periods of time, such as doing computer work or hairstyling
• Sleeping on the same arm each night
• Playing sports requiring the arm to be moved over the head repeatedly as in tennis, baseball (particularly pitching), swimming, and lifting weights over the head.
• Working with the arm overhead for many hours or days (such as painters and carpenters)
• Poor control or coordination of your shoulder and shoulder blade muscles

Poor posture over many years and the usual fraying of the tendons that occurs with age may also lead to rotator cuff tendinitis.

Rotator cuff tears may occur in two ways:

• A sudden or acute tear may happen when you fall onto your arm while it is stretched out, or after a sudden, jerking motion when trying to lift something heavy.
• A chronic tear of the rotator cuff tendon occurs slowly over time. It is more likely in those with chronic tendinitis or impingement syndrome. At some point, the tendon wears down and tears.

There are two types of rotator cuff tears:

• A partial tear is when a tear does not completely sever the attachments to the bone.
• A complete or full thickness tear refers to a through and through tear. It may be as small as a pinpoint or all of the muscle tendon. Complete tears have detachment of the tendon from the attachment site and would not heal very well.