Rotator Cuff Injuries

The rotator cuff is an integral musculotendinous component of the human shoulder complex. Although it serves a variety of functions, its most important one perhaps is to control the head of the humerus. The two major subgroups of rotator cuff injuries, impingement injuries and avulsive tears, result from compressive and tensile forces, respectively. In addition, either of these two conditions may be seen in association with calcifying tendonitis. The treatment of rotator cuff lesions typically emphasizes conservative measures. These may often consist merely of active rest and specific strengthening exercises. For patients who remain refractory to such therapy, however, arthroscopy or other surgical interventions may be necessary.

The fundamental principle that "structure dictates function" applies to most anatomic and physiologic considerations. Accordingly, any description of rotator cuff injuries must include a comprehensive depiction of the context in which they occur. The human shoulder is one of the least stable joint complexes of the human body (12:16). This instability, however, is compatible with its main purpose: i.e., the positioning of the hand in space. In fact, the shoulder's range of motion is so great, that it exceeds what is required for most daily activities (10:1).

The term, "shoulder complex" refers to three bones, the humerus, clavicle, and scapula, as well as their surrounding soft tissues (10:15). Precise movem

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oft, almost pastelike material. Conversely, it may also present as a hard, chalky, uninflamed region within the shoulder. In general, the cellular level mechanisms involved in the pathogenesis of calcification are not well understood. Histologically, the process appears to involve a metaplastic cellular transformation: tenocytes gradually evolve into chondrocytes. The result of this change is an increase of mucopolysaccharides with concomitant collagen disintegration in the surrounding tissue. Calcifying tendonitis may initially present in an acute phase. Symptoms may range from simple discomfort to severe pain. In some of these patients, the pain may be of sufficient severity to constitute an emergency. This typically results from a tendon's calcium deposits being under tremendous pressure. In addition, some of these patients will be discretely tender over the calcific area and not allow their shoulder to be moved. It may not be possible to perform a thorough physical examination until the disease has progressed to a subacute or chronic phase. The acute phase of calcifying tendonitis generally lasts about 2 weeks. Then, for about 3 to 8 weeks, a decrease in symptomatology may mark the subacute and chronic phases o

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