The rotator cuff is a group of muscles that run from the shoulder blade and attach to the head of the humerus (near end of upper arm bone). They function to rotate the shoulder and form a cuff or sleeve of muscle around the shoulder joint. This sleeve of muscle helps stabilise the shoulder which has a very shallow socket to allow for a high level of mobility. The rotator cuff are also important for controlling the position and movement of the head of the humerus. The muscles include:
- Supraspinatus
- Infraspinatus
- Teres minor
- Subscapularis
This shoulder problem may develop quickly due to an injury (acute), or it may develop slowly over time due to routine activity that causes a repetitive strain (chronic). Occasionally, a trivial movement e.g. putting on a coat can trigger a rotator cuff injury. The third variation of rotator cuff pathology is tendinitis.
Rotator Cuff Injury Causes
Chronic tear
- Found among individuals in occupations or sports involving excessive overhead activity e.g.decorators, tennis players
- Variations in the shoulder structure leading to narrowing under the outermost edge of the clavicle (collarbone)
Acute tear
- Sudden forceful raising of the arm against resistance e.g. in an attempt to cushion a fall on the shoulder
- Injury often associated with a significant degree of force in individuals younger under 30 years
Tendinitis
- Degeneration of the muscles as individual gets older
- Repetitive overuse of the muscles due to everyday activities
Rotator Cuff Injury Symptoms
Chronic tear
- More common on an individuals dominant arm
- More commonly found among individuals older than 40 years – especially men
- Pain normally worse at night and may affect sleep
- Gradually increasing pain levels with an associated weakness
- Decreasing ability to move the arm, especially abduction (raising out to side) – therefore difficulty performing activities at or above shoulder level.
Acute tear
- Sudden sensation of tearing followed by severe pain spreading through the arm
- Movement limited by pain and muscular spasm
- Acute pain due to bleeding and protective muscle spasm that usually subsides within in a few days
- Specific area of tenderness at the site of rupture
- With significant tears, individual unable abduct arm (raise the arm out to the side) without help
Tendinitis
- More common in 35-50 age group – especially women
- Pain felt as a deep ache in the shoulder
- Tenderness over specific areas
- Pain develops gradually and aggravated by lifting the arm to the side or turning it inward
- May develop into to a chronic tear
What you can do
- Rest the injured shoulder
- Apply ice therapy
- Apply heat therapy after 2-3 days of applying ice.
- Take an anti-inflammatory medication such as ibuprofen or naproxen sodium to decrease the pain and swelling. You must speak to your pharmacist or doctor first to ensure that the medication is suitable for you.
Treatment
Chronic tear
- Prescription of exercises to increase range-of-motion
- Referral for steroids injection or surgery is some cases
Acute tear
- Rest the arm by supporting the arm in a sling.
- Referral for imaging may be needed to determine the extent and muscle tear.
- Early surgical intervention (within three weeks) to repair the tendon maybe required if the injury is severe. Indications for surgical treatment:-
- Individuals under 60 years of age
- Failure to improve after six weeks of conservative treatment
- If individual is in an occupation requiring constant shoulder use
Tendinitis
- Rest shoulder in a sling for short periods. Extensive use of the sling can lead to stiffness, weakness, and reduced range of motion.
- Progress to contrast bathing as symptoms improve
- Prescription of exercises to increase range of motion of shoulder without placing stress on damaged muscles
- Massage therapy to reduce muscular tension in muscles of shoulder
- Stretches and joint articulation to improve range of motion
- Referral for steroid injection if symptoms do not resolve.
Tags: Rotator cuff, Shoulder injury, Shoulder pain
