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February 18, 2012

The Rotator cuff is 4 tendons, does it really need all that surgery?

People speak of the rotator cuff like it is a deep monster of the shoulder and when it rears its ugly head it needs to be beaten back with a surgeon's knife.  

The rotator cuff starts as 4 muscles attached to various parts of the shoulder blade.  Like all muscles they transition to tendons before they attach to the bone.  The 4 tendons of the rotator cuff cap the top of the humerus.  The job of the rotator cuff is to keep the ball of the humerus sitting on the very shallow joint it occupies.  

The shallowness of the joint allows it to have the remarkable range of motion it enjoys.  This joint moves our hands all over.  270 degree range of motion.  

So much of my time I spend talking to people about tears in their rotator cuff.  Not all tears require surgery. In fact, the vast majority of tears to not require surgery.  If you have a few nicks in the rotator cuff you can still rehab, strengthen and get rid of pain. Again the rotator cuff is still 4 muscles.  The other muscles can make up a bit for damage to one.  Additionally, just because there is a partial tear does not mean the muscle is shot.  Have you ever had a tear in your hamstring.  It still worked and you were able to get it back to a high level of functioning.  Remember 60% of 60 year olds have a tear in the rotator cuff.  They do not need surgery and maybe you do not either.  

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