Rotator cuff injuries
What are rotator cuff injuries?
Rotator cuff injuries are one of the most common types of shoulder injury. The rotator cuff is the name given to a group of four muscles and their tendons, which form a supportive cuff around the shoulder joint. Rotator cuff injuries refer to irritation, inflammation, or a tear to any of these muscles or tendons.
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Inflammation
A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.
The shoulder
The shoulder is a very mobile joint in your body. It is a ball-and-socket joint - the top bone of your arm, known as the humerus, is ball-shaped and fits into the socket of the shoulder bone (scapula). The joint is surrounded by a fibrous capsule that helps to hold all the parts of your joint together. The rotator cuff attaches around the shoulder joint to provide support and control shoulder movements. The rotator cuff comprises four muscles (and their tendons):
- Supraspinatus;
- Infraspinatus;
- Teres minor, and;
- Subscapularis.
The front view of a shoulder joint.
Many shoulder issues tend to involve the rotator cuff, such as inflammation, also known as tendonitis, tears, and impingement syndrome. As we get older our tendons lose strength and flexibility, so repetitive movements and overuse can lead to inflammation, pain and a reduced range of movement.
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Impingement syndrome
A progressive condition in which tendons in the shoulder become inflamed, causing pain and reduced function.
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Inflammation
A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.
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Tendonitis
Inflammation of tendons commonly due to overuse.
Causes
Rotator cuff injuries are very common and the causes include:
- Pulling or lifting a heavy weight, especially in a jerking motion;
- Falling onto your outstretched hand;
- Receiving a blunt impact, such as during a football tackle or in a bad fall;
- Continuing to use an already inflamed tendon, especially in sudden forceful movements;
- Repetitive movements, such as sawing wood;
- Awkward physical movements, such as painting a ceiling;
- Poor posture at work or rest, putting tendons under strain;
- Activities using repetitive overhead action such as bowling, tennis or volleyball, and;
- As you age, bone spurs can form within your shoulder causing further restriction and irritation to your tendons. These usually require surgical intervention.
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Tendon
Dense bands of connective tissue that attach muscles to bones.
Risk factors
Risk factors for rotator cuff injury include:
- Age - being over 40 significantly increases your risk;
- Poor posture or weak shoulder muscles;
- Doing repetitive overhead movements, such as painting ceilings, playing tennis or bowling a cricket ball. High-impact sports also put you at risk of a trauma injury;
- Previous shoulder surgery, injuries or structural problems, and;
- Smoking - this slows the healing process and reduces blood circulation to your joints.
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Trauma
1. Physical injury to the body caused by force or a toxic substance. 2. Psychological damage caused by a severely disturbing experience.
Signs and symptoms
Rotator cuff disorders usually cause weakness and pain, especially when attempting to lift your arm or reach above your head. The level of pain and weakness will depend on your specific injury.
It is possible to have a full or partial rotator cuff tear and not be aware of it, as symptoms can be confusing. The severity of symptoms do not necessarily match the severity of the injury. Smaller or partial tears can be incredibly painful, while full tears can sometimes cause little or no pain. Always get medical attention if you think you have injured yourself, even if you are unsure.
Signs of rotator cuff injury can include the following:
- Pain, often in the front part of your shoulder and arm;
- Weakness and inability to reach your arm behind your back, above your head, or lift or pull any weight;
- Being unable to lie or sleep on the affected shoulder;
- Deep, aching or throbbing pain that is worse with activity and better with rest;
- Pain that gets worse at night and makes it difficult to sleep;
- Clicking or popping sounds when you move the affected shoulder, and;
- Fear of moving the affected shoulder, preferring to keep it still.
Methods for diagnosis
Your doctor will take a full medical history and do a physical examination of your shoulder to find out what is causing your pain. The type of work you do, your age and how active you are will all be taken into consideration when seeking a diagnosis.
Musculoskeletal examination
Your doctor may ask you to perform a number of gentle arm movements, to check the range of movement in your shoulder. These movements will involve using each of the different muscles and tendons in your shoulder in a slow, methodical fashion. Quite often these tests are enough to diagnose where your pain is coming from.
Imaging tests
If the cause of your shoulder pain is still unclear you may have one of the following procedures:
- An ultrasound, which is a scan that uses high-frequency sound waves to produce images of your body's internal structures. Ultrasound is very useful in assessing soft tissue injuries of the shoulder, including rotator cuff injuries;
- An X-ray, which uses ionizing radiation to create an image of the bones in the shoulder joint;
- A computerized tomography (CT) scan, which sends X-ray beams from multiple angles using a machine that circles your body, and;
- Magnetic resonance imaging (MRI), which is similar to a CT scan, but uses magnetism and radio waves, instead of X-rays, to create an image of the body composed of multiple cross-sections that can be used to identify tissue damage. MRI and CT may be used in some circumstances for shoulder injury to provide more detailed images of bones and soft tissues.
Types of treatment
The majority of rotator cuff injuries can be treated at home without the need for surgery or medical intervention. However, if you have a full tear, you will probably need surgery to repair this.
Home care
A range of home-care measures can be used to treat rotator cuff injuries, including the following:
- Ice or heat packs - these can provide immediate relief from some types of pain, but experiment to see which one works best for you or seek advice from your doctor or physiotherapist regarding the most appropriate for your situation. Icepacks should not be placed directly on your skin, as they may cause nerve damage. First wrap the ice pack in a towel and only use for 10 minutes each time;
- Avoiding triggers - if you have an injury or inflammation due to overuse, the best remedy is to avoid that action until you have healed;
- Pain-relief medication - many types of shoulder pain will respond well to pain-relief medication such as ibuprofen or acetaminophen. To avoid stomach upsets, do not take ibuprofen or other anti-inflammatory medication on an empty stomach, and;
- Exercise and stretching - not using your shoulder can result in decreased muscle mass and further stiffness. Your doctor or physiotherapist can advise you on how to gently exercise your shoulder and increase blood flow to the area.
A shoulder sling and an icepack are used to treat a rotator cuff injury.
Shoulder injections
These injections use hydrocortisone, a corticosteroid, and/or local anesthetic to provide relief from inflammation and pain. They tend to be injected directly into the area that is most inflamed, allowing movement to return. Injections are only considered if rest and home care have not helped.
Physiotherapy
A physiotherapist is an expert in how muscles work and, in particular, how to rehabilitate them after an injury or sprain. They can assess the condition of your muscles, tendons and ligaments, then design exercise programs to strengthen them. Strapping your muscles with special tape may help keep your shoulder in place, reducing further injury while you recover. Your physiotherapist can teach you exercises and stretching techniques, which you can then use at home.
Surgery
Certain rotator cuff injuries, particularly tears and/or impingement syndrome, may require surgery. These are usually performed under a general anesthetic. They are increasingly being performed using arthroscopy, which uses small incisions to allow a camera and fine surgical instruments to perform the procedure, or mini-open repairs, which use slightly longer incisions to directly perform the procedure. Your surgeon can discuss the benefits and risks of these procedures.
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Anti-inflammatory
A substance used to reduce inflammation.
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Arthroscopy
A procedure that allows your doctor to see inside a joint, such as your knee or hip. An arthroscope is a tiny telescope with a light attached to its end. It is inserted via a small incision and guided through the joint needing examination.
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General anesthetic
An anesthetic given to a person to put them to sleep while having an operation or medical procedure. Afterwards, the person regains consciousness and usually has no memory of the procedure. A general anesthetic is given in hospital by a specialist called an anesthetist.
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Impingement syndrome
A progressive condition in which tendons in the shoulder become inflamed, causing pain and reduced function.
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Inflammation
A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.
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Local anesthetic
A type of medication that, when administered to an area, creates a localized loss of sensation by blocking nerve activity.
Potential complications
If you have long-term tendon problems, it may lead to arthritis in the affected joint. In some cases this can result in the need for surgery. Depending on the level of degeneration, you may be offered a joint replacement. In milder cases, arthroscopy and debridement of the existing bone surfaces may be helpful, where spurs or rough areas are shaved off, to smooth the joint surface.
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Arthroscopy
A procedure that allows your doctor to see inside a joint, such as your knee or hip. An arthroscope is a tiny telescope with a light attached to its end. It is inserted via a small incision and guided through the joint needing examination.
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Tendon
Dense bands of connective tissue that attach muscles to bones.
Prognosis
Rotator cuff injuries need to be properly assessed and treatment options followed, otherwise you may have reduced movement or use of the joint. Severe rotator cuff injury can result in a reduced range of motion and ongoing disability. Avoiding trigger factors such as repetitive, irritating movements is an essential part of your ongoing management of this condition.
Prevention
Some prevention measures include the following:
- Protect your shoulders in your day-to-day activities to help you avoid injury and damage;
- Do gentle stretching exercises daily, to maintain flexibility in your shoulders;
- Avoid activities that aggravate your shoulders, especially overhead lifting;
- Rest the affected joint as soon as symptoms return;
- Wear appropriate padding if involved in high-impact sports;
- Maintain good posture, sit upright and use an ergonomic work station;
- Try to stay flexible through exercise. Tai chi or yoga may help you to maintain smooth movement in your shoulders, and;
- Ask your physiotherapist to suggest specific exercises for your condition, to help you to avoid further injury.
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Ergonomic
The design of equipment for human use that is intended to maximize productivity by limiting fatigue and discomfort.
References
- Conditions and Symptoms - Shoulder Pain - Arthritis Victoria. Accessed 4 August 2014 from link here
- Frozen shoulder - Treatment - NHS Choices. Accessed 6 August 2014 from link here
- General Practice - 31 Jan 1998 - 9487172.pdf. Accessed 4 August 2014 from link here
- How does the shoulder work? | Arthritis Research UK. Accessed 5 August 2014 from link here
- Physiotherapy interventions for shoulder pain - The Cochrane Library - Green - Wiley Online Library. (-b). Accessed 4 August 2014 from link here
- Traumatic causes of acute shoulder pain and injury in children and adolescents. Accessed 4 August 2014 from link here
- Neck and shoulder pain - Better Health Channel. - Neck_and_shoulder_pain.pdf. Accessed 6 August 2014 from link here
- Rotator cuff injury | Bupa UK. Accessed 6 August 2014 from link here
- Rotator cuff tendinitis and tear. Accessed 18 August 2014 from link here
- Treatment Options for Rotator Cuff Tears: A Guide for Adults - Consumer Summary | AHRQ Effective Health Care Program. Accessed 6 August 2014 from link here
9 Most frequently asked questions (FAQs)
What are rotator cuff injuries? Rotator cuff injuries are one of the most common types of shoulder injury. The rotator cuff is the name given to a group of four muscles and their tendons, which form a supportive cuff around the shoulder joint. Rotator cuff injuries refer to irritation, inflammation, or a tear to any of these muscles or tendons. What are the symptoms of rotator cuff injuries? Rotator cuff disorders usually result in weakness and pain, especially when attempting to lift your arm or reach over your head. The level of pain and weakness may depend on the type and severity of your injury. Sometimes, small or partial tears can be more painful than full tears. Each case can be different. What causes rotator cuff injuries? Rotator cuff injuries are very common. Tears are often due to a sudden, jarring movement, or repeated use of a tendon. Overuse of your tendons, through repetitive actions or blunt impact, are the most common causes. Inflammation and restriction in movement, with tendons becoming pinched and less mobile are common reactions. This is usually a gradual process, brought on by years of usage. Who gets rotator cuff injuries? You are at greater risk of rotator cuff injury if you: are over 40 years of age; have poor posture or weak shoulder muscles; do repetitive overhead movements, such as painting ceilings, playing tennis or bowling a cricket ball; play high-impact sports, which puts you at risk of a trauma injury; have had previous shoulder surgery, injuries or structural problems, and; smoke. How is a rotator cuff injury diagnosed? To diagnose a rotator cuff injury, your doctor will take your medical history and ask you to perform gentle arm movements, to assess your tendons. This is often enough to make a diagnosis. Imaging tests such as MRI, ultrasound and X-ray are only needed if your doctor needs further clarification of your injury. How are rotator cuff injuries treated? Rest is often the best treatment for a rotator cuff injury. Avoiding triggering factors, performing gentle exercise, and applying either cold or heat packs are enough to calm down many cases. Pain-relief medications can often help treat moderate to severe pain. Occasionally, shoulder injections can be used if symptoms are ongoing. Surgery is generally recommended for full tears, and in certain other situations. What can be done at home to treat rotator cuff injuries? Many cases of rotator cuff injury can be fully treated at home, with rest being the best option. Avoid trigger factors and take pain-relief medications for the first few days. Ice or heat packs are effective in reducing pain and inflammation. Ice packs should not be placed directly on your skin, as they may cause nerve damage. First wrap the ice pack in a towel and only use for 10 minutes each time. What is the outlook for rotator cuff injuries? Rotator cuff injuries need to be properly assessed and treatment options followed, otherwise you may have reduced movement or use of the joint. Severe rotator cuff injury can result in reduced range of motion and ongoing disability. Avoiding trigger factors such as repetitive and irritating movements is an essential part of your ongoing management of this condition.
Related topics
The shoulder joint is surrounded by a fluid-filled capsule that holds fluid within the joint space. In frozen shoulder, the capsule thickens and swells due to the formation of bands of scar tissue within it. The joint becomes inflamed, painful and stiff and moves less freely. Polymyalgia rheumatica (PMR)
Polymyalgia rheumatica, or PMR, is inflammation of the shoulders and hips that causes pain and stiffness, often after sleep or rest. It is most often found in people over 50 years of age. PMR can be treated with low doses of corticosteroid medication. Shoulder pain is a common symptom. As the body’s most mobile joint, the shoulder comes under a great deal of stress throughout a lifetime. An overuse of shoulder muscles and tendons is a common cause of shoulder pain. Modifying certain activities can help prevent further shoulder pain. Anterior cruciate ligament (ACL) injury
Ligaments are bands of strong, flexible tissue that connect bones or cartilage, providing stability to joints. Knee ligament injuries can occur when your knee is hit forcefully, you land on it badly, or it sharply changes direction. Symptoms include swelling and pain, reduced movement, a popping sound, a feeling of instability and sometimes bruising.