Rotator Cuff Injury or Tear

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The rotator cuff is a group of muscles and tendons that attach to the bones of the shoulder joint, allowing the shoulder to move while keeping it stable. Rotator cuff tendinitis refers to irritation of these tendons and inflammation of the bursa which is the lining of these tendons.

A rotator cuff tear occurs when one of the tendons is torn from overuse or injury. The shoulder joint is a ball and socket type joint where the top part of the arm bone (humerus) forms a joint with the shoulder blade (scapula). The rotator cuff holds the head of the humerus into the scapula and controls movement of the shoulder joint.

The tendons of the rotator cuff pass underneath a bony area on their way to attaching the top part of the arm bone. When these tendons become inflamed, they can become more frayed over this area during shoulder movements. Sometimes, a bone spur may narrow the space even more. This problem is called rotator cuff tendinitis, or impingement syndrome, and may be due to:

  • Working with the arm overhead for many hours or days (such as in painting and carpentry)
  • Playing sports that require the arm to be moved over the head repeatedly as in tennis, baseball (particularly pitching), swimming and lifting weights over the head
  • Poor control or coordination of your shoulder and shoulder blade muscles
  • Keeping the arm in the same position for long periods of time, such as doing computer work or hairstyling
  • The usual fraying of the tendons that occurs with age can lead to rotator cuff tendinitis.

Rotator cuff tears may occur in two ways:

  • A sudden or acute tear may happen when you fall on your arm while it is stretched out, or after a sudden, jerking motion when you try to lift something heavy.
  • A chronic tear of the rotator cuff tendon occurs slowly over time. It is more likely in those with chronic tendinitis or impingement syndrome. At some point, the tendon wears down and tears.

There are two types of rotator cuff tears:

  • A partial tear is when a tear does not completely sever the attachments to the bone.
  • A complete or full thickness tear refers to a through and through tear. It may be as small as a pinpoint, or it may involve the entire tendon of one or more of the muscles. Complete tears have detachment of the tendon from bone, and typically do not heal without surgery.

Symptoms

Tendinitis or Impingement Syndrome:

Early on, pain occurs with overhead activities and lifting your arm to the side. Pain is more likely in the front of the shoulder and may radiate to the side of the arm. However, this pain always stops before the elbow. If the pain travels beyond the arm to the elbow and hand, this may indicate a pinched nerve.

There may also be pain with lowering the shoulder from a raised position. At first, this pain may be mild and occur only with certain movements of the arm. Over time, pain may be present at rest. Night pain is very common, especially when lying on the affected shoulder.

You may have weakness and loss of motion when raising the arm above your head. Your shoulder can feel stiff with lifting or movement. It may become more difficult to place the arm behind your back.

Rotator Cuff Tears:

The pain with a sudden tear after a fall or injury is usually intense. Weakness of the shoulder and arm is often present, along with a snapping sensation associated with certain movements.

Symptoms of a chronic rotator cuff tear include a gradual worsening of pain, weakness, and stiffness or loss of motion. The exact point when a rotator cuff tear begins in someone with chronic shoulder tendinitis may or may not be noticed.

Most people with rotator cuff tendon tears initially experience pain at night. Pain that is worse at night may wake you up. During the day, the pain is more tolerable and hurts primarily with certain movements. Over time, the symptoms become much worse and are not relieved by medicines, rest, or exercise.

Treatment

Tendinitis or Impingement Syndrome:

Treatment involves resting the shoulder and avoiding activities that cause pain. It may involve:

  • Ice packs applied 20 minutes at a time, 3-4 times a day to the shoulder
  • Taking drugs like ibuprofen and naproxen to help reduce swelling and pain
  • Avoiding or reducing activities that cause or worsen your symptoms

You should start physical therapy to learn exercises to stretch and strengthen the muscles of your rotator cuff. If the pain persists, or if therapy is not possible because of severe pain, a steroid injection may reduce pain and swelling in the injured tendons to allow effective therapy.

Arthroscopic surgery can remove some of the inflamed tissue and part of the bone that lies over the rotator cuff. Removing the bone may relieve the pressure on the tendons.

Rotator Cuff Tears:

Rest and exercise may help someone with a partial rotator cuff tear who does not normally place a lot of demand on the shoulder.

You may need surgery to repair the tendon if the rotator cuff has developed a complete tear, or if the symptoms persist despite conservative therapy. Most of the time, arthroscopic surgery can be used, even for very large tears. Occasionally open surgery is required.

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