The rotator cuff is a group of four muscles and their tendons that wrap around to form a “cuff” over the upper end of the arm at the shoulder. The rotator cuff helps guide the shoulder through many motions by allowing lift and rotation to the arm while stabilizing the ball of the shoulder within the socket. The space over the top of the rotator cuff is occupied by a bursa which is a fluid sac between the tendon and the acromion bone. Bursitis, a common condition, is inflammation of this fluid sac and occurs with repetitive overhead activity or overuse of the arm. The term impingement refers to pinching of the rotator cuff tendons and bursa against the acromion bone above it.
Bursitis around the shoulder can be caused by a repeated minor trauma such as overuse of the shoulder joint and muscles or a single more significant trauma such as a fall. In overuse type injuries, bursitis is often associated with impingement and tendonitis (inflammation) of the rotator cuff tendons
If pain and disability of the shoulder persist, despite nonoperative treatment, surgery may be considered. Surgery for bursitis or impingement surgery called a “subacromial decompression” involves removal of the inflamed bursal tissue over the rotator cuff and shaving of the acromion bone which can narrow the space above the rotator cuff. A partial rotator cuff tear may only require a trimming or smoothing procedure called a “debridement. However, if the tendon is completely torn away from its insertion on the humerus bone, it can be repaired directly to the bone.
Most surgical procedures can be performed on an outpatient basis. The surgical procedure in the majority of cases involves minimally invasive shoulder arthroscopy. Through the use of a tiny fiber optic scope and other small instruments inserted through small incisions, your physician can perform the bony shaving and tendon “debridement” under video control. This eliminates the need for a large, open incision.