Rotator Cuff Injury
A rotator cuff injury is an injury to one or more of the four muscles in the shoulder. This shoulder injury may come on suddenly and be associated with a specific injury such as a fall (acute), or it may be something that gets progressively worse over time with activity that aggravates the muscle (chronic). Occasionally, even a simple act like rolling over in bed can result in a rotator cuff injury.
The type of injury can range from an inflammation of the muscle without any permanent damage, such as tendinitis, to a complete or partial tear of the muscle that might require surgery to fix it.
The shoulder joint connects the upper arm to the upper part of the body. It consists of three bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone).
Rotator cuff tears are a common injury of a complicated joint. Because of our dependence on the shoulder for many activities, these injuries can be frustrating experiences. Learn more about rotator cuff tears, including diagnosis, symptoms, treatments and rehabilitation.
Rotator Cuff Tear Symptoms
The most common symptom of a rotator cuff problem is pain. Patients usually complain of pain over the top of the shoulder and arm. In some patients, the pain can descend down the outside of the arm all the way to the elbow.
The other common symptom of a rotator cuff tear is weakness of the shoulder. Weakness causes difficulty lifting the arm up overhead or difficulty with activities such as reaching, getting dressed, or carrying objects.
When should I seek medical attention for my Rotator Cuff Injury?
Seek medical attention if:
- The pain persists for more than 2-3 days
- You are unable to work due to the pain/limitations
- You are unable to reach up or to the side with the affected arm after 2-3 days
- You are unable to move the shoulder and arm at all
- For any acute injury where you are unable to move the injured shoulder as well as the uninjured shoulder
What can I do to help my rotator cuff muscles recover?
Treatment for an Acute Rotator Cuff Tear
- Apply ice to reduce swelling
- Control the pain with appropriate medications
- Rest the arm – a sling can sometimes be quite useful if you still need to go to work/school, which can be removed at night
- You may require imaging studies (x-ray, MRI, CT Scan) to identify what the problem is and rule out any fractures
- Consider consulting a physiotherapist who can assist you with rehabilitating the injury
If the injury is quite severe and you are young and active, you might require an operation to fix the tear.
- Under 60 years old
- Complete tears of the tendon/muscle
- Failure of other treatments after 6 weeks
- Professional/keen sports people
- If your job requires constant shoulder use
Treatment for a Chronic Rotator Cuff Tear
- Control pain
- Apply ice as above
- Alternating heat and ice may also be benficial.
- Sometimes you might be referred for an injection of steroid medication directly into the site of the problem to help reduce any inflammation and allow you to proceed with rehabilitation
- Shoulder exercises which can be provided by a physiotherapist
- You may require surgery, with the indications as above
How long will it take to get better?
- Depending on several factors, conservative treatment has a 40-90% success rate at fixing the problem.
- Surgery often has good results, with some studies citing a 94% satisfaction rate with the surgery, resulting in lasting pain relief and improved function. Very extensive tears often have a poor surgical outcome, however this injury is thankfully quite rare.
- If you are older, it will take you longer to heal due to changes in your physiology.
The rotator cuff muscles include:
- Teres Minor
Supraspinatus and Infraspinatus are the most commonly injured rotator cuff muscles. Due to the function of these muscles, sports which involve a lot of shoulder rotation – for example, bowling in cricket, pitching in baseball, swimming, kayaking – often put the rotator cuff muscles under a lot of stress.
Problems with the rotator cuff muscles can be classed into two categories – Tears of the tendons/muscles, and inflammation of structures in the joint.
This tends to happen as a result of a sudden, powerful movement. This might include falling over onto an outstretched hand at speed, making a sudden thrust with the paddle in kayaking, or following a powerful pitch/throw.
The symptoms will usually include:
- Sudden, tearing feeling in the shoulder, followed by severe pain through the arm
- Limited movement of the shoulder due to pain or muscle spasm
- Severe pain for a few days (due to bleeding and muscle spasm) which usually resolves quickly
- Specific tenderness (“x marks the spot”) over the point of rupture/tear
- If there is a severe tear, you will not be able to abduct your arm (raise it out to the side) without assistance
A chronic tear develops over a period of time. They usually occur at or near the tendon, as a result of the tendon rubbing against the overlying bone. This is usually associated with an impingement syndrome.
- Usually found on the dominant side
- More often an affliction of the 40+ age group
- Pain is worse at night, and can affect sleeping
- Gradual worsening of pain, eventually some weakness
- Eventually unable to abduct arm (lift out to the side) without assistance or do any activities with the arm above the head
- Some limitations of other movements depending on the tendon affected
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