The rotator cuff is a group of tendons that form the front, back and top of the shoulder. They cover the top of the upper arm bone (humerus) like a shirt sleeve "cuff." Four small muscles are attached to the rotator cuff, enabling a person to lift and rotate the arm. The other ends of the muscles are attached to a single tendon that anchors the rotator cuff to the shoulder blade (scapula).

A rotator cuff tear can occur from trauma. However, in most cases, minor trauma from overuse of the muscles and tendons over time leads to inflammation, degeneration and, eventually, a tear. Signs can include: pain when lifting or extending the arm, weakness in the shoulder, a clicking or popping sensation during shoulder movement and thinning of the muscles in the shoulder.

Rotator cuff tears are quite common. The American Academy of Orthopaedic Surgeons estimates up to 34 percent of Americans have some degree of tear. However the exact incidence isn't known because some people don't experience any symptoms. Tears are more common in people over 40 and among those who are involved in activities that require repetitive overhand motions (like baseball and tennis).

Treatment

Sometimes pain from a minor rotator cuff tear can be successfully treated with rest, immobilization and anti-inflammatory medication. Some patients may also benefit from steroid injections, exercises and physical therapy.

If these treatments aren't helpful, or if the pain is severe, surgery may be recommended. The goal of surgery for a rotator cuff tear is to reattach the tendon where it has torn away from the bone. The surgery may be performed through an open incision or through several smaller incisions with the help of a video camera and tiny surgical instruments. The tendon is attached to the bone with sutures and then held in place with titanium or bioabsorbable anchors.

The Double Row Suture Technique

In traditional surgical repair for a torn rotator cuff, the tendon is tacked down with a single row of sutures. However, Spero Karas, M.D., an Orthopaedic Surgeon with Emory University School of Medicine, says having a single fixation spot increases the tension on the tendon and increases the risk of another tear.

Karas uses a double row of sutures to attach the tendon to the bone at two points. The double row technique actually closely mimics the natural anatomy of the shoulder. In addition, having two contact points for the sutures strengthens the reattachment. Studies show the double row technique is associated with a much lower failure rate than a single row of sutures. And the stronger repair means a patient can start rehabilitation sooner and be a little more aggressive in their therapy program. Full healing takes about one year.

For general information on rotator cuff injury and treatment:

American Academy of Orthopedic Surgeons, public website

Arthroscopy Association of North America

National Institute of Arthritis and Musculoskeletal and Skin Diseases