Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Rotator cuff disease is damage to the rotator cuff from any cause.
This condition is one of the most common causes of shoulder pain.
How is the rotator cuff injured?
The rotator cuff can be injured because of degeneration with aging or
inflammation due to tendinitis, bursitis, or arthritis of the
shoulder. The rotator cuff is commonly injured by trauma (such as
from falling and injuring the shoulder or overuse in sports).
Rotator cuff injury is particularly common in people who perform
repetitive overhead motions that can stress the rotator cuff. These
motions are frequently associated with muscle fatigue.
What are symptoms of rotator cuff disease?
The most common symptom of rotator cuff disease is shoulder pain.
The pain is often noticed gradually and may be first noticed even a
day after the actual event which may have caused the injury.
Sometimes, a sudden pain occurs during a sport activity. The pain is
usually located to the front and side of the shoulder and is
increased when the shoulder is moved away from the body. The pain is
usually noted to be more intense at nighttime and sometimes increases
when lying on the affected shoulder. The pain can diminish and result in a frozen shoulder. There can also be tenderness in the area of the inflamed tendons of the injured rotator cuff.
People with rotator cuff disease usually find it difficult to lift
the arm away from the body fully. If the rotator cuff disease
involves severe tears of the rotator cuff tendons, it can be
impossible for the patient to hold the arm up because of pain.
How is rotator cuff disease diagnosed?
Rotator cuff disease is suggested by the patient's history of
activities and symptoms of pain in the shoulder described above. In
making a diagnosis, the doctor can observe increased pain with
maneuvers of the shoulder. The pain is due to local inflammation and
swelling in the injured tendons of the rotator cuff. Additionally, with severe tendon
tears of the rotator cuff, the arm falls due to weakness (positive
drop sign) when moved away from the body.
The diagnosis of rotator cuff disease can be objectively
confirmed by radiology testing. Sometimes plain x-rays can show bony injuries
which suggest long-standing severe rotator cuff disease when it has been present
for some time. An arthrogram involves injecting contrast dye into the shoulder
joint to detect leakage out of the injured rotator cuff. The MRI is a noninvasive imaging test which uses a
giant magnet and computer to produce fine images of the tissues of
the shoulder. An MRI has the added advantage of providing more
information than either X-ray or an arthrogram, especially if a
condition other than rotator cuff disease is present.
Shoulder bursitis is inflammation of the shoulder bursa. Bursitis may be caused by injury, infection, or a rheumatic condition. Symptoms include pain, swelling, tenderness, and pain with movement of the shoulder joint. Treatment may involve ice compresses, rest, and antiinflammatory medications and depends on whether there is an infection.
A frozen shoulder (adhesive capsulitis) is when the shoulder joint experiences a significant loss in its range of motion due to inflammation, scarring, or injury. Treatment involves anti-inflammatory medication, cortisone injections, and physical therapy.
Post-polio syndrome (PPS) is a group of signs and symptoms that show up two to four decades after the initial polio infection. Symptoms of PPS include fatigue, pain, sleep disorders, muscle twitching, gastrointestinal problems, and weakness. Treatment focuses on slowing down to conserve energy and relieving symptoms with pain relievers.
Calcific bursitis is the calcification of the bursa caused by chronic inflammation of the bursa. Calcific bursitis most commonly occurs in the shoulder. Calcific bursitis treatment includes medication for inflammation, ice, immobilization, cortisone injections, and occasionally surgical removal of the inflamed bursa.
Hydroxyapatite crystal disease is the inflammation caused by hydroxyapatite crystals. These tiny crystals of hydroxyapatite deposit by mistake in or around joints and may cause inflammation of the joints and nearby tissues such as the tendons and ligaments (particularly causing rotator cuff problems in the shoulder). Treatment options include rest, cold application, medications to reduce inflammation, and cortisone-related medication injections.
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