Rotator Cuff InjurySuprascapular Nerve InjuryImpingement SyndromeWrist SprainACL TearHomeFinger SprainAnkle SprainBoxers KnuckleBoxers FractureSlap LesionGroin StrainSnapping ScapulaAchilles TendonitisJersey FingerConcussionSkier's ThumbGamekeepers ThumbCarpal Tunnel SyndromeRadial Tunnel SyndromeEffort ThrombosisBack InstructionsTennis ElbowGolfer's ElbowAdductor StrainCast Care

 

Rotator Cuff Injury

ROTATOR CUFF INJURY

A rotator cuff tear is characterized by pain and weakness of the shoulder due to tearing of the rotator cuff tendons and is often associated with inflammation of the bursa (subacromial bursa). Rotator cuff tendonosis usually refers to the supraspinatus tendon that becomes inflamed from constant rubbing between a swollen subacromial bursa, bony spur, or by improper joint mechanics from weak rotator cuff stabilization muscles.

The rotator cuff is a series of four muscles that surround the ball of the shoulder (humeral head). The muscles attach to the shoulder blade on one side and to the humeral head on the other. The muscles attach to bone via tendons. The main function of the rotator cuff is to maintain the humeral head in the center of the socket. The rotator cuff is important in keeping the humeral head in the socket when initiating shoulder motion, such as to reach overhead or perform any activity that requires shoulder strength. The rotator cuff is also important in maintaining shoulder stability and in guiding shoulder motion.

Rotator cuff injuries in adolescents and young adults are usually associated with trauma or weak stabilizing muscles. In middle aged and older patients, the cause is usually chronic inflammation in the rotator cuff tendons causing small tears, fraying, and eventual rupture.

Symptoms may resolve spontaneously. However, rotator cuff injuries often do not heal on their own. Possible Complications include:  persistent pain, shoulder stiffness, recurrent pain or frozen shoulder, inability to return to same level of sports, even with surgery.

Symptoms

  • Pain along the outer portion of  the shoulder and upper arm
  • Pain that is worse with overhead activities or lifting
  • Aching pain at night, especially when sleeping on the affected side
  • Loss of strength
  • Limited motion of the shoulder, especially reaching behind (back pocket, bra) or across your body
  • Crepitation (a crackling sound) when moving the shoulder

Causes

Treatment

Initial treatment consists of relative rest, ice, medication to relieve pain, stretching and strengthening exercises. These all can be carried out at home, although working with a physical therapist or athletic trainer is usually more effective. The key to treatment usually involves strengthening the rotator cuff muscles and the scapula stabilizing muscles. Ice should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates symptoms.

 

An injection of cortisone into the area around the tendon may be recommended. In some patients, the tendon is pinched from a bone spur and surgery may be recommended to remove the spur or repair the damaged tendon. Surgery  is usually performed arthroscopically.

 

The initial phase of rest, ice, and steroid injection usually lasts 72 hours and is followed by a graduated program of stretching and strengthening. It is especially important to concentrate on increasing the endurance of the injured area muscles and supporting muscles to help prevent future injury. One often neglected part of rehabilitation involves re-training proprioception in the injured area. This has also been shown to help reduce the incidence of re-injury.