Rotator cuff is a common name for the group of 4 distinct muscles and their tendons that provide strength and stability during motion of the shoulder. The rotator cuff muscles are each used in a variety movements including flexion, abduction, internal rotation and external rotation. These muscles are essential in almost every type of shoulder movement. Balanced strength and flexibility in each of the four muscles are vital to maintain functioning of the entire shoulder girdle. As a group, the rotator cuff muscles are responsible for stabilizing the shoulder joint.
Rotator cuff injuries can occur at any age. In younger patients, most injuries occur secondary to trauma or arise from overuse due to overhead activities (e.g. volleyball, tennis, throwing). Incidence of overuse in younger athletes is becoming more common place due to the early specialization of sport. It is also seen with people who work with their arms overhead often like carpenters, painter, and plumbers.
Rotator Cuff Injuries
With increasing age some individuals with rotator cuff pathology may be asymptomatic and are usually degenerative in nature. Degenerative tears are typically due to:
- Repetitive stress
- Lack of blood supply
- Bone spurs
The most common injury to a rotator cuff is a tear. A rotator cuff tear is a common cause of pain and disability among adults. In 2013, almost 2 million people in the United States went to their doctors because of rotator cuff problems. Signs of injury include pain and weakness, which can limit daily activities like getting dress or even combing your hair. Pain is mostly provoked by overhead maneuvers and may weaken the shoulder.
The most common symptoms of a rotator cuff tear include:
- Pain at rest and at night, particularly if lying on the affected shoulder
- Pain when lifting and lowering your arm or with specific movements
- Weakness when lifting or rotating your arm
- Crepitus or crackling sensation when moving your shoulder in certain positions
It is important to differentiate shoulder pain coming from places other than the shoulder, such as the neck or elbow, through a thorough history and physical examination.
Rotator cuff muscles cannot be seen on X-rays but calcifications, arthritis or bone deformations – that are common causes for rotator cuff pathologies – may be visible. The most common imaging method to evaluate rotator cuff pathologies is MRI, which can detect tears and inflammation.
In about 80% of patients, nonsurgical treatment relieves pain and improves function in the shoulder.
Nonsurgical treatment options may include:
- Rest. Your doctor may suggest rest and limiting overhead activities. He or she may also prescribe a sling to help protect your shoulder and keep it still.
- Activity modification. Avoid activities that cause shoulder pain.
- Nonsteroidal anti-inflammatory medication. Drugs like ibuprofen and naproxen reduce pain and swelling.
- Strengthening exercises and ART (Active Release Technique). Specific exercises will restore movement and strengthen your shoulder. Your exercise program will include stretches to improve flexibility and range of motion. Strengthening the muscles that support your shoulder can relieve pain and prevent further injury. ART can reduce the amount of adhesions within the tissue layers being formed by scar tissue that can cause pain and restrict ranges of motion.
- Acupuncture. Stimulates local blood flow and the body’s innate healing response. Acupuncture is also excellent at reducing pain during the recover process.
- Steroid injection. If rest, medications, and physical therapy do not relieve your pain, an injection of a local anesthetic and a cortisone preparation may be helpful. Cortisone is a very effective anti-inflammatory medicine; however, it is not effective for all patients.
Contact us if you have any further questions.