A rotator cuff injury is a tear, sprain, strain, or inflammation of the rotator cuff muscles or tendons in the shoulder. They connect the upper arm bone with the shoulder blade.
Rotator cuff injury is known by several names, including pitcher's shoulder, swimmer's shoulder, and tennis shoulder. As these names imply, the injury occurs most frequently in athletes in sports requiring the arm be moved over the head repeatedly, such as weightlifting. Rotator cuff tendinitis is an inflammation of the shoulder tendons while a rotator cuff tear is a ripping of one or more of the tendons.
Tendons of four muscles make up the rotator cuff. The muscles are the supraspinatus, infraspinatus, teres minor, and subscapularis. The tendons attach the muscles to four shoulder bones: the shoulder blade (scapula), upper arm bone (humerus), and the collarbone (clavicle.) The rotator cuff tendons can also degenerate due to age, usually starting around age 40.
A rotator cuff injury includes any type of irritation, inflammation, or damage to the rotator cuff muscles or tendons. Types of injuries and conditions include:
Rotator cuff injuries are fairly common in athletes, including baseball pitchers and people whose shoulder muscles and tendons are subjected to repetitive motion, such as javelin and shotput throwers. They occur mostly in males, especially those over age 40. Younger males can also injure the rotator cuff; injuries in high school and college baseball players is not uncommon.
There are areas of the rotator cuff tendons that have poor blood supply, causing the tissue to heal and maintain itself from normal use. These regions in particular are slow to heal following a strain or tear. Tearing and inflammation in athletes is usually due to hard and repetitive use, especially in baseball pitchers. In nonathletes over age 40, the injuries usually occur during improper lifting of heavy objects.
Normal wear and tear, poor posture, and falling are common causes of rotator cuff injuries. Fitness-related causes include:
The two primary symptoms of a rotator cuff injury are pain and weakness in the shoulder or arm. A partial tear may cause pain but still allow normal arm movement. A complete tear usually leaves the injured person unable to raise the arm away from the side.
Symptoms of a rotator cuff injury include:
Diagnosis is usually made after a physical examination, often by a sports medicine physician or an orthopedic surgeon. X-rays are sometimes used in diagnosis but the most effective test is an arthrogram. A magnetic resonance imaging (MRI) scan or ultrasound scan is sometimes used to determine muscle and tendon tears.
The primary treatment is resting the shoulder and, for minor tears and inflammation, applying ice packs to reduce inflammation and pain. Over-the-counter non-steroidal anti-inflammation medications can be used for pain. These drugs include aspirin, ibuprofen (Advil and Motrin), naproxen (Aleve), and acetaminophen (Tylenol). Anti-inflammatory medications may also be prescribed by a physician. As soon as pain decreases, physical therapy is usually begun to help regain normal range of motion. If pain persists after several weeks, the physician may inject cortisone into the affected area.
Serious tears to the rotator cuff tendons usually require surgery to repair. Sometimes during surgery, bone spurs or calcium deposits are removed. The surgery is performed either as an open incision or arthroscopy. Arthroscopy uses a small fiber-optic scope inserted through a small incision in the skin to see inside the shoulder. It allows surgeons to view joint problems without major surgery. Depending on the problem that is found, surgeons may use small tools inserted through additional incisions to repair the damage, such as a torn tendon that fails to heal naturally. Using arthroscopy, for example, a surgeon may reattach the torn ends of a ligament or reconstruct the ligament using a piece (graft) of healthy ligament from the patient. Because arthroscopy uses tiny incisions, it results in less trauma, swelling, and scar tissue than conventional surgery, which in turn decreases hospitalization and rehabilitation times. Problems can be diagnosed earlier and treated without serious health risks or more invasive procedures. Furthermore, since injuries are often addressed at an earlier stage, operations are more likely to be successful. Other surgical options include partial or total shoulder replacement.
There are no effective alternative medicine treatments for rotator cuff injuries.
The prognosis for recovery from minor rotator cuff injuries is excellent. For serious injuries, the prognosis is usually good, but requires up to six weeks of physical therapy following surgery. Full recovery may take several months. In rare cases, the injury is so severe it requires tendon grafts and muscle transfers. If a tendon has been torn for too long, the injury may not be repairable.
The best prevention is to avoid repetitive overhead movements and to develop shoulder strength in opposing muscle groups. Other preventative measures include doing regular shoulder exercises, taking frequent breaks from activities that use repetitive arm and shoulder motions, sufficiently resting the shoulders during sports that require repetitive arm motion, and applying application of heat or cold at the first indication of shoulder pain or soreness.
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American Physical Therapy Association, 1111 N Fairfax St., Alexandria, VA, 22314, (703) 684-2782, (800) 999-2782, Fax: (703)684-7343, firstname.lastname@example.org, http://www.apta.org .
American Shoulder and Elbow Surgeons, 9400 W. Higgins Rd., Ste. 500, Rosemont, IL, 60018, (847) 698-1629, Fax: (847)268-9499, email@example.com, http://www.ases-assn.org .
National Institute of Arthritis and Musculoskeletal and Skin Diseases, 1 AMS Circle, Bethesda, MD, 20892, (301) 495-4484, (877) 22-NIAMS (226-4267), Fax: (301) 718-6366, NIAMSinfo@mail.nih.gov, https://www.niams.nih.gov .
Ken R. Wells