What is the rotator cuff?
A rotator cuff is a group of four tendons that stabilize the shoulder joint. The tendons hook up to the four muscles that move the shoulder in various directions.
There are four muscles whose tendons form the rotator cuff:
- the subscapularis muscle, which moves the arm by turning it inward (internal rotation);
- the supraspinatus muscle, which is responsible for elevating the arm and moving it away from the body;
- the infraspinatus muscle, which assists the lifting of the arm during turning the arm outward (external rotation); and
- the teres minor muscle, which also helps in the outward turning of the arm.
What are types of rotator cuff injury?
- 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 causes rotator cuff injuries?
Rotator cuff disease is damage to the rotator cuff from any cause.
- It can be from an acute injury or from repetitive strains.
- This can lead to a minor strain injury, a partial tear of the tendons, or a complete tear of tendons with loss of shoulder joint function.
- Rotator cuff injury is one of the most common causes of shoulder pain.
Risk factors for rotator cuff disease include any activity that involves sudden strain movements of the shoulder against resistance. These include
- lifting weights,
- lifting overhead,
- sports where objects are thrown (baseball or softball pitchers,
- football quarterbacks, etc.), and
- taking luggage off of racks, etc.
What are the symptoms of rotator cuff injuries?
The most common symptom of rotator cuff injuries is shoulder pain.
- The pain is often noticed gradually and maybe first noticed even a day after the actual event that may have caused the injury. Sometimes, sudden pain occurs during a sports 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 the range of motion and movement of the arm.
- The inflammation from the rotator cuff disease and the lack of movement due to pain can 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 and decreased function of the tendons and muscles.
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Diagnosis of rotator cuff injuries
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 certain movements 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 arm sign) when moved away from the body.
The diagnosis of rotator cuff injury can be confirmed by radiology testing.
- Sometimes X-rays can show bony injuries, which suggest long-standing severe rotator cuff disease.
- 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 that uses a magnet and computer to produce detailed 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.
Specialists who treat rotator cuff disease include generalists, including
- general practitioners,
- family practitioners, internists, as well as orthopedic surgeons,
- rheumatologists, and
- physical therapists.
What is the treatment for rotator cuff injuries?
The treatment of rotator cuff disease depends on the severity of the injury to the tendons of the rotator cuff and the underlying condition of the patient.
- Mild rotator cuff disease is treated with ice, rest, and anti-inflammatory medications (such as ibuprofen [Advil, Motrin] and others). Generally, physical therapy using gradual exercise rehabilitation is instituted.
- Exercises are used that are specifically designed for rotator-cuff strengthening.
- Patients with persistent pain and motion limitation can often benefit from a cortisone injection around the rotator cuff. Repeat injections may be necessary.
- More severe rotator cuff disease can require surgical repair.
- Subacromial decompression is the removal of a small portion of the bone (acromion) and soft tissues (bursa) that surround the rotator cuff.
- This removal can relieve pressure on the rotator cuff in certain conditions and promote healing and recovery.
- This procedure can be done by arthroscopic or open surgical techniques.
- Both methods have been reported to be equally successful.
- The most severe rotator cuff disease, complete full-thickness rotator cuff tears, usually require surgery for the best results.
- These procedures, which can also be done by either arthroscopy or open surgery, involve mending the torn rotator cuff by suturing the tissues back together.
- Ultimately, recovery from rotator cuff disease often requires extended physical therapy and rehabilitation.
Are there home remedies for rotator cuff injuries?
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What are complications of rotator cuff injuries?
What is the prognosis for rotator cuff injuries?
- Without treatment, the shoulder can permanently lose full function from rotator cuff injury.
- Minor rotator cuff injuries cause mild to moderate dysfunction.
- Severe rotator cuff injuries can cause complete dysfunction of the shoulder joint. Scarring around the shoulder (adhesive capsulitis) can lead to a marked restriction of the range of shoulder motion (frozen shoulder).
- Extensive need for rehabilitation and physical therapy is the norm with significant rotator cuff injury.
- Some patients never recover the full function of the shoulder joint.
Is it possible to prevent rotator cuff injuries?
- Rotator cuff disease can be prevented by avoiding injury to the tendons of the shoulder.
- Rotator cuff injuries can also be prevented by strengthening the rotator cuff muscles with exercises designed for this purpose.
- Repetitive strains, especially arm movements over the head, should be limited.
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Koopman, William, et al., eds. Clinical Primer of Rheumatology. Philadelphia, Pa: Lippincott Williams & Wilkins, 2003.
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