Rotator Cuff Injuries
Rotator cuff injuries often result in an inability to raise the arm above the level of the shoulder. That means a real change in the way that you can get dressed, go to work, play sports and even play with your children. But the damage, unless it”s a significant tear, doesn”t have to result in permanent disability.
Before the correct treatment can be prescribed, depending upon the amount of damage and whether it”s a result of chronic, acute, tendonitis or anatomical reasons, a doctor must diagnose the injury and the causative agents. Without this basic information your treatment could result in even more damage.
When you arrive at the doctor the first thing that they”ll do is a history of the event. The medical history will help them to determine the cause of the injury, any immediate symptoms and any chronic symptoms, as well as how the injury may be impeding your current daily activities.
After a history they”ll do a physical examination to compare the range of motion and strength in both shoulders. To do this you”ll have to put on a gown so that the doctor can more fully evaluate the shoulders for any redness or swelling that may indicate another problem in the joint.
During the examination the doctor will carefully feel the entire shoulder and the one that isn”t injured to compare sides. The doctor will evaluate the range of motion of the shoulder both actively – you doing the movement – and passively – when they move the shoulder while you”re relaxed. If the doctor believes there might be a broken bone in the shoulder this part of the exam can be delayed.
Included in a physical exam will be an evaluation of neurological innervation, or rather sensation impairments in the arm. They”ll also evaluate blood flow to the arm. Some doctors will do this first before causing discomfort with the range of motion to get a more accurate evaluation.
Doctors will perform several tests in the office, the most common of which is the drop arm test. You will stand facing the doctor and raise your arm to 90 degrees. The doctor will apply a slight pressure to your wrist or hand which may cause you to drop your arm. This gives your doctor an indication of the severity of the injury.
Most often an x-ray is ordered if the doctor wants to rule out a potential broken bone. In the case of a rotator cuff injury an x-ray is normal without any deformities. There are other more advanced imaging studies that might be ordered if there isn”t any improvement after a month of treatment and consistent rehabilitation. Doctors may use an arthrography, ultrasound or MRI to determine the amount of degeneration to the tendons and ligaments. The exact test ordered will be determined based on the amount of damage that the doctor believes is present and the age of the patient.
The rotator cuff is not really a cuff but rather an area in the shoulder where tendons, ligaments and muscles, which control arm movement from the shoulder, are located. These ligaments and tendons control the arm”s ability to rise out to the side of the body. With specific movement comes specific pain when there is an injury – either chronic or acute.
Rotator cuff injuries can be chronic, found in people who participate in occupations or sports that have excessive overhead movements such a painter, or baseball pitchers. Chronic injuries also occur in people who have an anatomic narrowing of the space in the shoulder which causes damage to the tendons with movement. Chronic injuries are also caused by tendonitis with degeneration in age or repetitive trauma.
Rotator cuff injuries can also be caused from acute trauma to the joint such as when there is significant pressure against the shoulder during a fall, raising something overhead or a direct trauma to the shoulder. In people younger than 30 there is usually significant force to the shoulder to cause damage.
Each of the different injuries to the rotator cuff has different symptoms if it is chronic or acute. In a chronic tear the symptoms happen more in the person”s dominant arm because that is the side that receives the most trauma during repetitive movement. Chronic tears are more common in men older than 40.
In an acute rotator cuff injury there is usually a tearing sensation followed by intense pain down the arm. Motion in the arm will be limited by pain and muscle spasms. The acute pain from the tear and bleeding into the muscle goes away in a short time, usually 3-5 days. There will continue to be point tenderness over the point of the tear and if the tear is significant the person won”t be able to raise their arm out to the side of their body.
In either case, chronic or acute, the pain is generally located to the front and side of the shoulder and becomes more intense when the shoulder is moved away from the body. Interestingly the pain also becomes more intense at night and will increase when lying on the affected shoulder. As the pain gradually worsens it can also be accompanied by weakness. The person experiencing rotator cuff injury can usually still use the arm but will be unable to move the arm above the level of the shoulder.
As the pain diminishes if the person doesn”t continue to move the shoulder it can result in a ‘frozen shoulder’. In other words the joint loses a significant amount of range of motion in all directions, even when the patient is relaxed and the doctor attempts to move the arm. Inflammation, scarring, thickening and shrinkage of the capsule all contribute to the frozen shoulder and resulting loss of function and increased pain with movement.
Rotator cuff injuries are sometimes precipitated by a chronic tendonitis. Tendonitis in the shoulder is most common in women between 35 and 50 years old. They also experience a deep ache in the shoulder toward the front and outside of the upper arm. There is usually point tenderness. Women describe the pain as coming on gradually and becoming worse when they lift their arm to the side or turn it inward – the action used when glancing at a watch. This type of tendonitis can lead to a tear in the ligaments and tendons from chronic inflammation.
If these symptoms sound familiar then you should seek medical care if the shoulder pain lasts more than 2 days or you aren”t able to work or raise your arm above the level of your shoulder. If you aren”t able to engage in your daily activities or sports activities then you should schedule a visit to your doctor. Emergency medical attention should be sought if you are suddenly unable to move your shoulder whether it was immediately injured or not.
Rotator cuff injuries can be relatively minor or make a large impact in your ability to accomplish daily living tasks. Certainly without physical therapy and rehabilitation the latter will be the most likely result of either a chronic or acute injury. As with any other injury or damage done to the body, if you give your body the right tools early in the injury you are more likely to suffer less long-term problems than if you neglect the problem and then try to fix it later.
Rotator Cuff Treatment
Treatment of a rotator cuff injury is dependent upon the severity of the injury and the cause of the injury. An acute injury will be treated differently from an injury caused by anatomical abnormalities or chronic tendonitis. Most often there is an exercise program involved to improve the strength of the muscles surrounding the shoulder to help protect the shoulder from further damage.
The doctor will most likely recommend that you rest the shoulder initially and apply ice for 20 minute periods 3 times a day. There are varying beliefs about using ice and heat. Most agree that ice is used in the first 2 days. After that there are those that believe using heat will help to heal the area faster and those that believe continuing to use ice will be best. Whichever recommendation you and your physician agree to do not mix the two; ice or heat but not both.
You can take an anti-inflammatory medication such as ibuprofen to decrease the pain and swelling in the joint. Do not make the mistake of taking the medication and over using the shoulder because the pain has decreased. Also, do not take medication if you have an allergy or other medical conditions. You should always consult with your doctor before starting a medication that may interfere with other medications you may be taking, including over the counter drugs.
Once the initial inflammation, swelling and pain have decreased you should be enrolled in a physical therapy program to help strengthen the shoulder and increase the range of motion. Your therapist will give you exercises to do at home with an exercise band that are simple but require consistency to see results. Without therapy you may experience the same symptoms in a rather short amount of time.
If you have persistent pain and limited mobility your doctor may recommend cortisone injections to help decrease the inflammatory response in the shoulder. If the rotator cuff injury is severe they may recommend a surgical repair so that you can regain much of the range of motion you”ve lost.
In some cases the repair will remove a portion of the bone that lies over the rotator cuff area to relieve the pressure on the tendons and ligaments. When the pressure is released the inflammation will decrease and thus healing is encouraged.
Most patients prefer to have any surgery done arthroscopically – through a small hole in the shoulder – but sometimes a full repair necessitates an open incision. With an open incision there is a greater risk of infection and post surgical complications as well as an increased recovery time. However, when there is a significant tear to the tendon then an open repair is necessary to regain function in the shoulder.
Rotator cuff injuries are relatively common among women 35-50 and men over 40. As a result of the fast paced lives we lead there is a real tendency to neglect strengthening exercises, stretching and gradual increases in weight lifting. We want results and we want them now. Don”t make the mistake of assuming that your joints will accept the challenges that you will upon them. Take the time to stretch, strengthen and move slowly through an intense exercise routine. Use compensatory equipment if you are constantly keeping your hands over your head. And when there are signs of injury or inflammation, don”t ignore them.
Without treatment for rotator cuff injuries you risk permanently losing full function of the shoulder and arm from rotator cuff disease. Sometimes there is scarring around the shoulder which leads to a restriction in the range of motion of the shoulder or increased pain.
It is normal to go through weeks of rehabilitation to improve the function and decrease the pain of a rotator cuff injury. Don”t be discouraged! There is definitely a light at the end of this injury. With vigilant work and consistent therapy you should recover full function, full range of motion and strength in your shoulder.
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