Rotator Cuff Injury

Overview

Rotator cuff injuries are common, especially as people get older. Physical therapy, rest, and anti-inflammatories can all help. In some circumstances, a torn rotator cuff needs surgery to fix.

A set of muscles and tendons in your shoulder is known as the rotator cuff. They assist you in lifting your arms away from your body and moving them away from your body. The rotator cuff is a ligament that holds the ball of the upper arm bone (humerus) in place in the shoulder blade socket.

The shoulder is a skeletal system joint that consists of a ball and socket joint. Tendons pull away from the arm bone, causing rotator cuff tears. Overuse or other damage might cause a tear.

Anatomy

The three bones that make up your shoulder are the humerus (upper arm bone), scapula (shoulder blade), and clavicle (collarbone). The ball, or head, of your upper arm bone fits into the shallow socket in your shoulder blade, forming a ball-and-socket joint.

The essential components of the shoulder are highlighted in this picture.

Your rotator cuff keeps your arm in its shoulder socket. The rotator cuff is a group of four muscles that form a covering around the head of the humerus via tendons. The rotator cuff connects the humerus to the shoulder blade and aids in arm lift and rotation.

The rotator cuff tendons assist you to raise and rotate your arm covering the head of the humerus (upper arm bone).

Between the rotator cuff and the bone on top of your shoulder is a lubricating sac called a bursa (acromion). The bursa allows the rotator cuff tendons to travel smoothly as you rotate your arm. When the rotator cuff tendons are ripped or injured, this bursa can become inflamed and painful.

Description

The tendon no longer entirely connects to the head of the humerus when one or more of the rotator cuff tendons is damaged.

The supraspinatus tendon is the most commonly torn, however other portions of the rotator cuff may also be affected.

In many cases, torn tendons begin by fraying. The tendon might totally tear as the injury proceeds, which can happen when lifting a big object.

There are different types of tears.

• Partial tear. An incomplete tear is another name for this sort of tear. The tendon has been injured, but it is not completely severed.
• Full-thickness tear. A full tear is another name for this type of rip. It separates the tendon from the bone completely. There is essentially a hole in the tendon with a full-thickness rip.

Cause

A fall, for example, can result in a broken collarbone or dislocated shoulder, tearing the rotator cuff. Rotator cuff tears are more likely as the tendon deteriorates with age and use (degenerative tear). People over the age of 40 are the most vulnerable.

Causes of degenerative tears include:

• Bone spurs: On the top of the shoulder bone, bony growths can occur. When you elevate your arm, the bone spurs rub against the tendon. Friction between the bone and the tendon is caused by this shoulder impingement. A partial or complete tear may develop at some point.
• Decreased blood flow: As you become older, blood flow to the rotator cuff declines. Your muscles and tendons require a steady supply of blood to repair themselves. The tendons can tear if they don’t get enough blood.
• Overuse: Repetitive shoulder movements in sports or at work can cause a tear in the muscles and tendons.

Risk Factors

Anyone can experience a rotator cuff tear. These factors may increase your risk:

• Shoulder difficulties or rotator cuff injuries in the family.
• Poor posture.
• Smoking.
• Being age 40 or older.

Degenerative tears are more likely in those who do the same repetitive shoulder movements over and again, for example:

• Carpenters.
• Mechanics.
• Painters.
• Athletes who play baseball, softball, tennis, or are members of a rowing crew, both amateur and professional.

Symptoms

Rotator cuff injuries can affect people of all ages. Some people are good candidates for surgery, while others will need to try an alternative.

Over time, your rotator cuff can be injured due to wear and tear or incorrect movement patterns. Two movement habits that put your rotator cuffs at risk include slouching and persistently thrusting your head forward. Calcium deposits in the shoulder area, as well as bone spurs caused by arthritis, can irritate or constrict the rotator cuff as you become older.
Repetitive stress is another factor to consider. Repetitive stress injuries of the shoulder are common among tennis players, swimmers, and baseball pitchers, as well as carpenters and painters.
Rotator cuff injuries can in a variety of forms. Overuse can cause tendons to become irritated, ripped, or partially torn. Bursitis can also cause pain in your shoulder. The bursa, a fluid-filled sac that sits between your rotator cuff and your shoulder joint, becomes inflamed and irritated with this condition.

Symptoms of a rotator cuff injury include:

• shoulder weakness
• not wanting to move your shoulder
• shoulder pain, especially when you lift, pull, and reach behind your back or overhead
• a reduction in the range of motion of your shoulder joint

How is a rotator cuff tear diagnosed?

The importance of a medical history and a physical exam in the diagnosis of rotator cuff problems cannot be overstated. You’ll need to obtain a thorough medical history. This is the moment to tell your doctor about your fitness and activity habits. Your doctor will also do a physical examination. During the examination, they will perform a series of maneuvers to locate the source of your pain.

Following that, your doctor will conduct a series of tests to confirm the diagnosis. Shoulder X-rays, an MRI, or an ultrasound may be used. An MRI takes photos of the structures and organs inside your body using radio waves and magnetic fields. Ultrasound creates images of your interior organs using sound waves. Each of these tests yields a slightly different result of the internal structure of your shoulder.

Your doctor will determine whether rotator cuff repair surgery is the best treatment choice for you based on the exam findings and imaging test results. If surgery is being considered, your surgeon may want to use an arthroscope to examine your shoulder more. A tiny camera will be used to examine your rotator cuff during an arthroscopy. You’ll be given a numbing drug for your shoulder before the treatment begins. The camera, which is connected to a video monitor, will next be inserted through a small incision in your shoulder by your doctor. This camera will be used by your surgeon to examine your tendons, ligaments, and cartilage to see if surgery can assist with your shoulder difficulties.

Treatment

Nonsurgical Treatment
Nonsurgical treatment reduces pain and improves shoulder function in roughly 80% of patients.

Nonsurgical treatment options may include:

• Rest. Rest and reducing overhead activity may be recommended by your doctor who may also suggest that you wear a sling to help protect and stabilize your shoulder.
• Activity modification. Shoulder-inducing activities should be avoided.
• Nonsteroidal anti-inflammatory medications (NSAIDs). Ibuprofen, aspirin, and naproxen are anti-inflammatory medications that relieve pain and swelling.
• Physical treatment and strengthening exercises Specific exercises can help you regain movement in your shoulder and strengthen it. Stretching will be part of your workout to enhance flexibility and range of motion. The muscles that support your shoulder can be strengthened to ease pain and avoid further injury.
• Injection of steroid An injection of a local anesthetic and a cortisone preparation may be useful if rest, drugs, and physical therapy did not relieve your discomfort. Cortisone is a powerful anti-inflammatory drug, however it is not appropriate for everyone.

Surgical Treatment

If nonsurgical measures fail to relieve your discomfort, your doctor may propose surgery. The major reason for surgery is persistent pain. Your doctor may recommend surgery if you are very active and use your arms for overhead work or sports.
Other indications that surgery might be a good choice for you are:

• You’ve had your symptoms for 6 to 12 months
• You have a substantial tear (greater than 3 cm) with good surrounding tissue quality
• You have considerable shoulder weakness and loss of function
• A recent, acute injury caused your tear.

The tendon is usually reattached to the head of the humerus after surgery to repair a torn rotator cuff (upper arm bone). Rotator cuff tears can be repaired in a variety of ways. Your orthopedic surgeon will discuss the best procedure for your specific health needs with you.

Risks of Rotator Cuff Repair

Infection, nerve injury, and severe bleeding are all hazards associated with surgery. Patients may have allergic responses to anesthesia or have respiratory problems during the surgery though this is in extremely uncommon situations. Discuss any concerns you have about your procedure with your doctor.

Recovery from Rotator Cuff Repair

Following surgery, your doctor may advise you to wear a sling for four to six weeks. It’s also possible that you’ll need to wear a shoulder brace. Shoulder immobilizers come in a variety of forms, but they always appear like a short sleeve with a strap across your chest. This keeps your shoulder in place and protects it.

Because shoulder surgery can be uncomfortable, your doctor may also prescribe pain medicine. You might wish to start physical therapy once you start to feel better. Your muscle strength and range of motion will be restored with therapy.
Depending on the severity and form of your shoulder injury, recovery could take anywhere from three to six months.