A rotator cuff injury can cause a dull ache in the shoulder, which often worsens when you try to use your arms. The pain may disturb your sleep and reduce the range of motion in the arm, such as an inability to lift the affected arm to the side. Rotator cuff injuries may be the result of either a substantial injury to the shoulder or progressive degeneration in the form of wear and tear of the tendon tissue.
The rotator cuff is a group of tendons and muscles in the shoulder, connecting the humerus (upper arm) to the scapula (shoulder blade). The rotator cuff tendons provide stability to the shoulder, while the muscles allow the shoulder to rotate.
Rotator cuff tears may be caused by:
- Wear and tear of the tendon tissue: When there is a good blood supply, the body has a natural ability to repair tendon damage. However, the low blood supply in the rotator cuff tendons can ultimately lead to a tendon tear.
- Repetitive shoulder movements: As the tendon tissues degenerate, the symptoms will become worse. The tendons of the rotator cuff can tear from long-term repeated actions.This is common in athletes who regularly use repetitive arm motions, such as baseball players. However, the damage can also be caused from repeated daily activities, such as cleaning windows, washing cars and painting.
- Overuse of the rotator cuff: The damage can also be caused by lifting objects that are too heavy, by falling, or from sustaining certain types of injury such as a heavy impact injury to the shoulder.
Rotator cuff tears are most common in people over 40 who have had shoulder problems in the past. Lifting heavy objects may damage the tendon. However, young people may also experience rotator cuff injury due to long-term overuse or accident.
The most common symptoms of a rotator cuff tear include pain and weakness of the shoulder. The pain and weakness increases in line with the severity of the rotator cuff tear. When you have a small rotator cuff tear, you can often still raise your arm with only mild pain. However, with a large rotator cuff tear, you may find that you are unable to move your arm normally or lift your arm to the side. In most cases, the pain occurs only when lifting the arm. In some extreme cases, patients can’t sleep due to the relentless pain.
To diagnose the rotator cuff tear, the doctor will first review the patient’s medical history, including illnesses, accidents and pain. The doctor will then examine the shoulder. Rotator cuff tears can be easily tested. If the doctor can move your arm fully, but you can’t do it by yourself, then there is a good chance that you have a rotator cuff tear.
Where necessary, the doctor may use x-rays to check for bone spurs, fractures or other abnormalities that are associated with rotator cuff tears. In addition, Magnetic Resonance Imaging (MRI) may be used to create highly detailed images of the muscles, bones and tendons in the shoulder.
Treatments options for rotator cuff tears include non-surgical treatments and surgical treatments. The doctor will choose the most appropriate option for each patient based on the results of the diagnosis and other relevant factors.
- Non-surgical treatments:
- Rest and anti-inflammatory medication: Aspirin or ibuprofen may relieve the pain and inflammation. If the pain does not go away, cortisone injections may be recommended.
- Physical therapy: The doctor may consult with a physical therapist to develop a rehabilitation program for the patient. Initially, the objective is to relieve the pain and inflammation by applying hot or cold packs to the affected shoulder. Next, exercises will restore movement and strengthen the shoulder. After that, physical therapy exercises will improve the flexibility and strength of the muscles surrounding the shoulder joint. Physical therapists will help ensure that the ball of the humerus is firmly maintained in the shoulder socket, enabling the patient to move the affected arm normally. In most cases, patients can perform routine activities and use their arms normally after 6-8 weeks of physical therapy.
- Surgical treatments: If the patient wants to regain normal use of the arms, rotator cuff surgery may be required. However, surgery is not an option for patients who are elderly or at greater risks due to certain health conditions. It has been proven that the best results occur when the rotator cuff repair surgery is performed within 3 months of the initial damage. However, patients should consult with their doctor about the appropriate time for surgery. In patients with partial rotator cuff tears, surgery may not be required due to the body’s natural ability to repair damage. However, surgery may be considered when the pain is relentless pain or if the patient is unable to use the arm.
By Dr. Withoon Boonthanomwong, Orthopedist, Orthopedic Center, Bumrungrad Hospital
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