Causes of Injury
Rotator cuff injuries make up a significant portion of the 6 million shoulder injuries each year in the United States. With the greatest range of motion of any joint in the body, the shoulder’s unique anatomy predisposes the rotator cuff to the significant stress. The rotator cuff is a system of four small muscles off the scapula that have the confluent tendons surround the humeral head. They control motion and initiate elevation of the shoulder.
Wear and tear: As you age, everyday activities begin to take a toll on the rotator cuff tendons. The rotator cuff tendon lies between the humeral head and the acromion (a cap of bone over the top of the shoulder). A lubricating structure called the bursa is on the upper surface of the cuff tendons. The friction of activity can lead to inflammation of the bursa (bursitis) or the tendon (tendinitis) with pain and loss of function. This is called an impingement syndrome. If this continues over time, fiber failure can occur with a rotator cuff tear developing.
Trauma: Sudden trauma to the rotator cuff from using your arm to break a fall or during a collision on the field can tear or bruise the rotator cuff tendon or muscles.
Repetitive stress: Repeated overhead motion of your arms can lead to inflammation and even tear the rotator cuff. This often afflicts those in building trades, such as painters, carpenters, and construction workers. Athletes are also vulnerable, especially swimmers, baseball players, and tennis players.
Pulling and lifting: Straining and tearing the rotator cuff tendons and muscles can occur if you lift an object that is too heavy or if you improperly lift an overhead object.
Diagnosis
The diagnosis is made with a thorough history, physical examination, and appropriate imaging studies.
These may include a combination of the following:
Magnetic Resonance Imaging (MRI)
X-rays
Arthrogram with CT Scan
Ultrasound
Diagnostic Arthroscopy
Non-Surgical Treatments
Non-surgical treatments are the cornerstone of treatment and diagnosis. It can require some patience. It can take anywhere from several weeks to several months to get back to full strength or range of motion. The vast majority of patients will improve with conservative management and will not need surgical consideration.
Rest: Resting the injured joint is the first step to reduce swelling and pain. Be sure to keep using the arm gently. Keeping it immobilized can lead to a painful condition called frozen shoulder.
Ice: In the first 24 hours of an injury, ice it to reduce swelling and pain.
Heat: After 24 hours have passed, a heating pad or hot compress can help.
NSAIDS (non-steroidal anti-inflammatory drugs): Reduce pain and swelling through NSAIDS such as ibuprofen (Advil), naproxen (Aleve), or aspirin.
Physical therapy and exercise: Gentle exercises and stretches designed to strengthen the muscle can treat many rotator cuff injuries.
Steroids: Cortisone can be injected directly into the bursa to reduce inflammation and pain, but steroid injection should be used under the careful direction of a doctor. Multiple injections should be avoided.
Surgical Treatments
Most rotator cuff injuries are treated non-surgically, but Dr. Nicholson may do surgery if a rotator cuff is torn or if months of physical therapy and other treatments have not helped.
Common surgeries to correct rotator cuff include:
Impingement Surgery (also called Acromioplasty or Subacromial Decompression)
Arthroscopic Rotator CUFF Repair Surgery
For more information about rotator cuff diagnosis and treatment, please contact our office.