Surgical Orthopedics - Specialist Clinic for Orthopedics

Definition of the Clinical Picture

A rotator cuff is a group of muscles and tendons surrounding the shoulder joint and firmly hold the head of your humerus in the shallow shoulder socket. A rotator cuff injury can cause dull pain in your shoulder that often worsens when your arm is rotated away from your body.

Rotator cuff injuries are common and increase with age. They may occur earlier in people who have jobs that require repetitive overhead movements, among others, painters and carpenters.

Causes

A rotator cuff rupture can result from an acute injury such as a fall or be caused by chronic wear with degeneration of the tendon or a combination of acute and chronic causes. Impingement of the front of the scapula, the “acromion,” on the tendon is thought to be a major cause of cuff tears in individuals older than 40 years.

Several factors contribute to degenerative or chronic rotator cuff ruptures:

  • Repeated stress – If you keep repeating the same shoulder movements, you can stress the rotator cuff muscles and tendons. Baseball, tennis, rowing, and weightlifting are examples of sports activities that put you at risk for overuse. Many jobs and routine tasks can lead to overuse.
  • Lack of blood supply – As we age, the blood supply to our rotator cuff tendons decreases. The body’s natural ability to repair tendon damage is compromised without a good blood supply, which can eventually lead to a torn tendon.
  • Bone spurs – At an older age, bone spurs (bone growth) often develop underneath the acromion bone. When we lift our arms, the spurs rub against the rotator cuff tendons. Over time, this condition weakens the tendon and increases the likelihood that it will tear.

Symptoms

The signs and symptoms of a rotator cuff rupture depend on the tear’s size and the extent, and how long it has been present. In most cases, pain is the predominant feature of inflammation around the damaged tendon and mechanical entrapment of the tendon in its tunnel under the acromion. Pain occurs when using the arm, especially when elevated to and above shoulder level. Pain also occurs at night, which is particularly annoying because sleep is disrupted. Depending on the size of the rupture, weakness, associated loss of strength, and loss of motion may occur.

The most common symptoms of a rotator cuff rupture:

  • Pain at rest and night, especially when you lie on the affected shoulder
  • Pain when raising or lowering the arm and during certain movements
  • Weakness when you raise or rotate your arm
  • Crepitus or crackling when you move your shoulder in certain positions

Ruptures that develop slowly due to overuse also cause pain and can induce arm weakness. You may have pain in your shoulder when you lift your arm to the side or pain moving over your arm. At first, the pain may be mild and only occur when you lift your arm overhead, e.g., reach into a cabinet. Over-the-counter medications such as aspirin or ibuprofen may relieve the pain at first.

Over time, the pain may become more noticeable at rest and do not subside with medication. You might suffer pain when you lie on your painful side at night. The pain and weakness in your shoulder may make routine activities, such as combing your hair or reaching behind your back, difficult.

Diagnostic

A detailed medical history is raised, a thorough physical examination carried out, and an X-ray image of the shoulder performed. An MRI confirms the cause and also helps determine the exact treatment plan.

Therapy

The goal of any treatment is to relieve pain and restore function. There are several treatment options for a rotator cuff rupture, and the best option is different for each patient. When planning your treatment, your doctor will consider your age, activity level, overall health, and type of rupture.

Surgical treatment is unnecessary if pain and loss of function are not significant problems, depending on your age and the circumstances the rupture occurred. Non-surgical treatment includes analgesics and physiotherapy to strengthen the rotator cuff muscles, provided this does not worsen the problem. Steroid injections are especially useful in the early stages.

Surgery is recommended if you have persistent pain or weakness and loss of function that does not improve with nonsurgical treatment. Often, patients who need surgery report pain at night and difficulty using the arm for lifting and reaching. Many patients report persistent symptoms despite several months of medication and limited use of the arm.

Non-surgical treatment options may include:

  • Rest – Your doctor may suggest resting and limiting overhead activities.
    Activity modification – Avoid activities that cause shoulder pain.
  • Nonsteroidal anti-inflammatory medications – Medications such as ibuprofen relieve pain and swelling.
  • Physical therapy-Specific exercises restore motion and strengthen your shoulder. Your exercise program will include stretching to improve flexibility and range of motion.
  • Strengthening the muscles that support your shoulder can relieve pain and prevent further injury.
  • Steroid injection – If rest, medication, and physical therapy do not relieve your pain, an injection of a local anesthetic and a cortisone medication may be helpful.

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