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Definition

What is rotator cuff injury?

The rotator cuff is a group of muscles and tendons that surround the shoulder joint, keeping the head of your upper arm bone firmly within the shallow socket of the shoulder. A rotator cuff injury can cause a dull ache in the shoulder, which often worsens when you try to sleep on the involved side.

Rotator cuff injuries occur most often in people who repeatedly perform overhead motions in their jobs or sports. Examples include painters, carpenters, and people who play baseball or tennis. The risk of rotator cuff injury also increases with age.

How common is rotator cuff injury?

Please discuss with your doctor for further information.

Symptoms

What are the symptoms of rotator cuff injury?

The common symptoms of rotator cuff injury are:

  • Be described as a dull ache deep in the shoulder
  • Disturb sleep, particularly if you lie on the affected shoulder
  • Make it difficult to comb your hair or reach behind your back
  • Be accompanied by arm weakness

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

Not all shoulder pain arises from the shoulder. Sometimes angina, or pain from coronary artery disease from the heart, can be referred to the shoulder. Pain from the gallbladder or diaphragm can also be felt in the shoulder region, often in the shoulder blade area. Pain from a rotator cuff injury is worsened with shoulder movement.

If the unexplained shoulder pain is not affected by movement, it is reasonable to seek immediate medical care. If there is concern that the pain is coming from the heart, emergency medical services should be activated.

Causes

What causes rotator cuff injury?

The muscles and tendons in the rotator cuff group may be damaged in a variety of ways. Damage can occur from an acute injury (for example from a fall or accident), from chronic overuse (like throwing a ball or lifting), or from gradual degeneration of the muscle and tendon that can occur with aging.

Acute rotator cuff tear

  • This injury can develop from sudden powerful raising of the arm against resistance or in an attempt to cushion a fall (for example, heavy lifting or a fall on the shoulder).
  • A rotator cuff tear requires a significant amount of force if the person is younger than 30 years of age.

Chronic tear

  • Chronic rotator cuff tears are typically found among people in occupations or sports requiring excessive overhead activity (examples, painters, baseball pitchers, tennis players).
  • The chronic injuries may be a result of a previous acute injury that has caused a structural problem within the shoulder and affected the rotator cuff anatomy or function (for example, bone spurs that impinge upon a muscle or tendon, causing inflammation).
  • Repetitive trauma to the muscle by everyday movement of the shoulder.
  • A chronic tear may lead to degenerative changes to the tendon, leading to worsening pain, decreased range of motion, and decreased function.

Tendinitis

  • Degeneration (wearing out) of the muscles and tendons with age
  • This usually occurs where the tendon attaches to bone. The area has poor blood supply and a mild injury may take a long time to heal and potentially lead to a secondary tear of the cuff.
  • Calcific tendinitis describes a condition characterized by calcium deposits that develop within the tendon itself where it has sustained chronic inflammation.

Glenohumeral subluxation

  • If the shoulder joint is unstable and loose, the rotator cuff needs to work harder to make certain the joint does not partially dislocate (subluxate) with movements.
  • Repetitive stress of these muscles can lead to rotator cuff muscle weakness, discomfort, and chronic injury.

Risk factors

What increases my risk for rotator cuff injury?

There are many risk factors for rotator cuff injury, such as:

  • As you get older, your risk of a rotator cuff injury increases. Rotator cuff tears are most common in people older than 40.
  • Certain sports. Athletes who regularly use repetitive arm motions, such as baseball pitchers, archers and tennis players, have a greater risk of having a rotator cuff injury.
  • Construction jobs. Occupations such as carpentry or house painting require repetitive arm motions, often overhead, that can damage the rotator cuff over time.
  • Family history. There may be a genetic component involved with rotator cuff injuries as they appear to occur more commonly in certain families.

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is rotator cuff injury diagnosed?

History

The care provider may want to take a thorough history of the acute injury as well as any previous symptoms that may suggest a more long-term problem.

Physical Exam

The physical examination often involves observation to look for deformities, muscle wasting, and changes in the appearance of the damaged shoulder compared to the normal one.

Palpation means touching, including feeling the bones that make up the shoulder joint, as well as the shoulder joint itself. These bones include the clavicle (collarbone), scapula (shoulder blade), and humerus (upper arm bone). The muscles of the shoulder may be palpated, trying to find areas of tenderness or pain.

Evaluation may include the assessment of range of motion of both shoulders. This may be done both passively (as one sits down or lies on one’s back and the examiner gently moves the arm in all directions) and actively (the patient moves the arm as far as possible in all directions). This part of the examination may be delayed or not done if a broken bone is suspected. The power of the shoulder muscles can also be assessed this way, depending upon whether the patient can move the shoulder against resistance or perhaps just lift the arm up against gravity.

Sensation and blood flow in the arm and hand may be assessed, feeling for pulses and determining if there is normal light touch, pain, and vibration sensation in the extremity.

The neck may also be examined, depending on the age of the person, cause of injury, and symptoms to make certain that the pain in the shoulder is not referred pain from conditions of the cervical spine.

The health care provider may ask about chest pains or trouble breathing to make certain that the shoulder pain is not referred from the heart.

A variety of tests may be performed to try to decide which of the four muscles of the rotator cuff is injured or damaged. Each uses muscle contractions to try to find the weak or painful muscle. Examples include the Jobe test for the supraspinatus tendon, the Patte test for the infraspinatus and teres minor muscles, and the Gerber test for the subscapularis muscle.

X-rays

Plain X-rays are usually taken as a screening exam to look for broken bones or arthritis and bone spurs within or adjacent to the shoulder joint. Sometimes, calcification can be seen along the tendon. Often, the plain X-ray findings are normal in rotator cuff injury.

Advanced Imaging Studies

Magnetic resonance imaging (MRI): The MRI has become the test of choice for most significant shoulder injuries. This test is able to identify all the structures that make up the rotator cuff and can identify degeneration changes, partial or complete tears of the tendons and muscles, or a combination of all these conditions. Dye may be injected into the shoulder by a radiologist to help better visualize the tissues in the image.

Ultrasonography: This is a sound wave test that can help evaluate damaged tendons and muscles but has difficulty in assessing the bones of the shoulder. The benefit of ultrasound is that it can be done as the shoulder is moved and can find places where the rotator cuff is being pinched or impinged upon. However, the quality of ultrasound depends upon the skill and experience of the ultrasound technician and radiologist performing the test.

How is rotator cuff injury treated?

Initial treatment of a rotator cuff injury begins with rest, ice, and physical therapy to strengthen the muscles of the rotator cuff and to reestablish full range of motion of the shoulder. It may take weeks or longer to reach satisfactory healing.

There are other nonsurgical options available for treatment of rotator cuff injuries, including steroid injections to decrease inflammation in the tight spaces where the muscle tendons run across the shoulder joint, therapeutic ultrasound, shockwave therapy, and dry needling.

If early conservative treatments don’t work or if there is a complete tear of the rotator cuff, surgery may be the next alternative to repair those tears that have been identified. As well, other problems may be addressed at time of surgery including debridement (cleaning up) of bone spurs, relieving any areas of muscle or tendon impingement, tightening the joint capsule, or repairing a labrum tear.

An orthopedic surgeon may use an arthroscope (an instrument that is inserted through a small incision) to repair the damage. Depending upon the procedure to be done, an open surgical procedure may be contemplated, where an incision is made into the joint area to allow the repairs to occur.

Early surgery may be offered to athletes who may want an earlier potential return to play.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage rotator cuff injury?

The following lifestyles and home remedies might help you cope with rotator cuff injury:

  • Rest your shoulder. Stop doing what caused the pain and try to avoid painful movements. Limit heavy lifting or overhead activity until your shoulder pain subsides.
  • Apply ice and heat. Putting ice on your shoulder helps reduce inflammation and pain. Use a cold pack for 15 to 20 minutes every three or four hours. After a few days, when the pain and inflammation have improved, hot packs or a heating pad may help relax tightened and sore muscles.
  • Take pain relievers. Over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB), naproxen sodium (Aleve) or acetaminophen (Tylenol, others) may be helpful.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Review Date: October 19, 2017 | Last Modified: October 19, 2017

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