Rotator cuff injury is a strain or tear of the rotator cuff. The rotator cuff is made up of muscles and four separate tendons that fuse together to surround the shoulder joint.
Causes
Causes of a rotator cuff injury include:
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Direct blow to the shoulder area
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Falling on an outstretched arm
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Repetitive overhead motion of the arm such as in:
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Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Risk factors for a rotator cuff injury include:
Symptoms
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Recurrent, constant pain, particularly when reaching overhead
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Pain at night that prevents you from sleeping
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Shoulder muscle weakness, especially when lifting the arm
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Popping or clicking sounds when the shoulder is moved
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Limited range of motion in the shoulder joint
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. The doctor will carefully examine your shoulder. You will be asked to move your shoulder in several directions.
Tests may include:
X-ray–to rule out fractures and bone spurs.
Arthrogram–dye is injected into the shoulder joint and then an x-ray is taken. The doctor will look for dye that leaks out of the joint, which indicates a tendon tear.
MRI scan–a test that uses magnetic waves to make pictures of the inside of the shoulder. This will show bones and tendons, and is an excellent way to determine either large or small tears of the cuff.
Arthroscopy–a thin, lighted tube is inserted through a small incision in the shoulder to look at the structures inside the shoulder. Arthroscopy can also be used for treatment.
Ultrasound–a test that uses sound waves to examine the rotator cuff for inflammation or tears.
Treatment
The treatment will depend on the extent of your injury, level of pain, and amount of immobility. The first step is usually a nonsurgical approach.
Nonsurgical
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Rest–to help the shoulder heal. The doctor may recommend that you wear an arm sling to help rest the shoulder area.
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Nonsteroidal anti-inflammatory drugs (NSAIDs)–to help control the pain.
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Corticosteroid injections–to help reduce swelling and pain.
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Ice–to help reduce swelling and pain. Apply ice to shoulder area for 15 minutes, 3-4 times a day.
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Physical therapy–to help decrease inflammation and restore strength and motion to the shoulder area.
Surgical
Arthroscopy–A small instrument is inserted into the shoulder and used to remove bone spurs or degenerated portions of the rotator cuff tendons. Lesser tears can be repaired during arthroscopy as well.
Mini-open repair with arthroscopy–This combines arthroscopy with an incision in the shoulder joint. Through the incision, the doctor can suture larger tears in the tendons.
Open surgery–This is used to repair the injured tendon in more severe cases. A tissue transfer or a tendon graft can be done during surgery if the tear is too large to be closed together. In the most severe cases, a joint replacement may be necessary.
Recovery
Depending on the extent of your injury, full recovery can take anywhere from 2-6 months, and sometimes longer.
Prevention
To reduce your chances of getting a rotator cuff injury:
RESOURCES:
American Academy of Orthopaedic Surgeons
http://www.aaos.org
The American Orthopaedic Society for Sports Medicine
http://www.sportsmed.org
References:
American Academy of Orthopaedic Surgeons website. Available at: http://www.aaos.org/.
National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/.
