Rotator Cuff Injuries
Rotator Cuff Injuries
If you’ve been struggling with pain, weakness, or reduced range of motion in the shoulder for more than a few days, you could have injured something called the rotator cuff. In this article, we describe rotator cuff injuries, their symptoms, how they’re diagnosed and treated, and what you can do to prevent them.
What is a Rotator Cuff Injury?
The rotator cuff is a group of tendons and muscles that are located around the shoulder joint. They stabilize the joint and allow movement of the shoulder and arm. Problems occur when one or more muscles and tendons of the rotator cuff become damaged or irritated. A rotator cuff injury can result in symptoms like a dull ache, especially when you move the arm away from the body.
Sometimes, a rotator cuff tear occurs from a single injury. In such cases, it is important to seek medical attention as soon as possible. Surgery may be required to fix the rotator cuff injury. In most cases, however, rotator cuff injuries occur from progressive degeneration, i.e., normal wear and tear that affects soft tissues over time.
Different Grades of Rotator Cuff Injuries
In this video, Dr. Orcutt explains how injuries are graded.
Risk Factors for Rotator Cuff Injuries
Rotator cuff injuries are common in older individuals, i.e., their incidence increases with age. People whose occupations require them to perform heavy lifting or repetitive overhead motions, for example, carpenters and painters, are at a higher risk of rotator cuff injuries due to irritation and damage of the tendons. Athletes who play sports like baseball that require overhead pitching are also susceptible to rotator cuff injuries.
Scientists have also discovered a genetic predisposition to rotator cuff injuries, meaning they tend to occur more frequently in some families.
Symptoms of Rotator Cuff Injury
The main symptom of a rotator cuff injury is shoulder pain. Many patients describe the pain as a dull ache deep in the shoulder joint. The pain is often worse at night, to the point that of disturbing sleep. There can be accompanying arm weakness and limited range of motion, making it difficult for you to perform daily activities such as reaching behind your back, reaching up for something, or combing your hair.
Read on to learn more
Complication from Rotator Cuff Injuries
You should see a healthcare practitioner if you are experiencing symptoms suggestive of a rotator cuff injury. If treatment is delayed, a rotator cuff injury can lead to several complications, such as stiffness of the shoulder joint or adhesive capsulitis (commonly called frozen shoulder). Prompt diagnosis of rotator cuff injuries and institution of an early rehab program with range of motion exercises can minimize the chance of developing painful conditions like frozen shoulder. Resting the shoulder is required for recovery from a rotator cuff injury; however, keeping the shoulder immobile for a prolonged period can cause the joint to become tight.
Diagnosis of Rotator Cuff Injuries
Doctors diagnose a rotator cuff injury by physical examination. Your healthcare provider will press on different parts of the shoulder and have you move your arm in different directions. They will also test the strength of the rotator cuff muscles. In some patients, the doctor may recommend an imaging study, such as an X-ray, ultrasound, or MRI scan.
An X-ray cannot show a rotator cuff injury, but it can help rule out other causes of shoulder pain, such as a bone spur or arthritis. MRI is an imaging modality that can display the structures of the shoulder in exquisite detail. Your doctor may order an MRI scan to assess the location and extent of a rotator cuff injury.
Treatment of Rotator Cuff injuries
Many patients can obtain relief of symptoms with conservative treatment measures like rest, ice, and pain medications. Physical therapy exercises can help restore strength and flexibility to the shoulder. The exercises can be tailored to strengthen specific muscles affected by a rotator cuff injury.
For a more severe rotator cuff injury that does not respond to conservative treatment, your doctor may recommend steroid shots into the shoulder joint, especially if your shoulder pain is interfering with sleep or preventing you from doing your daily activities. It is worth noting that pain medications and steroid shots offer temporary relief of symptoms. Also, steroids must be used with caution because long-term use can weaken the tendons and cause further joint damage.
If the rotator cuff injury is severe, your doctor may recommend surgery. Several different types of surgeries are performed for rotator cuff injuries, including:
- Open tendon repair, in which the surgeon makes a cut and reattaches a damaged tendon to the bone.
- Arthroscopic repair of tendon, in which the surgeon uses a device called an arthroscope (a tiny camera) and inserts tools through a small incision to reattach
- Torn rotator cuff tendons
- Supracapsular reconstruction in which a graft is used to hope partially reproduce the rotator cuff function
- Shoulder replacement, in which an artificial joint is used as a replacement in patients with massive rotator cuff injuries
Preventing Rotator Cuff Injuries
If you are at risk of a rotator cuff injury (for example, due to family history) or you’ve had a rotator cuff injury in the past, you can prevent the problem from recurring by performing daily shoulder strengthening and range of motion exercises. It is worth remembering that in addition to the muscles of the shoulder, arm, and front of the chest, the muscles at the back of the shoulder (around the shoulder blade) also need to be strengthened to give the joint stability. It may be worth seeking a consultation with a physical therapist to develop an exercise routine that you can do at home every day.
In most people, the pain from a rotator cuff injury diminishes with conservative treatment. However, it’s important not to ignore shoulder pain that doesn’t go away after a few days. A healthcare provider can diagnose and treat a rotator cuff injury promptly and prevent further complications.