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Rotator Cuff Injury

Definition


Disease: Rotator Cuff Injury Rotator Cuff Injury
Category: Bones, joints, muscles diseases
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Disease Definition:

The muscles and tendons in the shoulder make up the rotator cuff. These muscles and tendons connect the upper arm bone with the shoulder blade. They also help hold the ball of the upper arm bone firmly in the shoulder socket. The greatest range of motion of any joint in the body is the result of this combination.

Any type of irritation or damage to the rotator cuff muscles or tendons is included in a rotator cuff injury. Falling; lifting; and repetitive arm activities especially those done overhead, such as throwing a baseball or placing items on overhead shelves may be included in the causes of a rotator cuff injury.
With self-care measures or exercise therapy, most rotator cuff injuries heal on their own.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Symptoms of rotator cuff injury may include:

  • Inclination to keep the shoulder inactive.
  • Pain and tenderness in the shoulder, especially when reaching behind the back, lifting, reaching overhead, pulling or sleeping on the affected side.
  • Loss of shoulder range of motion.
  • Shoulder weakness.


Pain is the most common symptom. When the patient carries something heavy, bends his/her arm back to put on a jacket or reaches up to comb the hair, he/she may experience pain. It may also be painful to lie on the affected shoulder. The patient may experience continuous pain and muscle weakness when having a severe injury, such as a large tear.

A person should see a doctor when:

  • Being unable to use the arm.
  • Having shoulder pain that has lasted for more than a week.
  • Experiencing severe shoulder pain.

Causes:

The upper arm bone (humerus) connects with the shoulder blade (scapula) by four major muscles (subscapularis, supraspinatus, infraspinatus and teres minor) and their tendons. Any type of irritation or damage to the rotator cuff muscles or tendons is involved in a rotator cuff injury, which is fairly common; these types include:

  • Strain or tear: Tendinitis can weaken a tendon and lead to chronic tendon degeneration or to a tendon tear if it's left untreated. Stress from overuse also can also cause a shoulder tendon or muscle to tear.
  • Tendinitis: Tendons in the rotator cuff can become inflamed due to overuse or overload, especially if the person is an athlete who performs a lot of overhead activities, such as in tennis or racquetball.
  • Bursitis: The fluid-filled sac (bursa) between the shoulder joint and rotator cuff tendons can become irritated and inflamed.

The common causes of rotator cuff injuries include:

  • Repetitive stress: Causing inflammation and eventually tearing, rotator cuff muscles and tendons may stress because of repetitive overhead movement of the arms. This occurs often in athletes, especially baseball pitchers, swimmers and tennis players. This is also common among people in the building trades, such as carpenters and painters.
  • Normal wear and tear: Normal wear and tear on the rotator cuff can cause a breakdown of fibrous protein (collagen) in the tendons and muscles of the cough, increasingly after age 40. They will be more susceptible to injury and degeneration because of this. Calcium deposits may also develop with age within the cuff or arthritic bone spurs that can pinch or irritate the rotator cuff.
  • Lifting or pulling: The tendons or muscles may strain or tear because of lifting an object that's too heavy or doing so improperly, especially overhead. An injury may also result from pulling something, such as a high-poundage archery bow.
  • Falling: Using the arm to break a fall, or falling on the arm can bruise or tear a rotator cuff tendon or muscle.
  • Poor posture: The space where the rotator cuff muscles reside can become smaller when a person slouches his/her neck and shoulders forward. The muscle or tendon may become pinched under the shoulder bones as well as the collarbone because of this, especially during throwing or other overhead activities.


The risk of having a rotator cuff injury may increase due to the following factors:

  • Having weak shoulder muscles: With shoulder-strengthening exercises, this risk factor can be decreased or even eliminated.
  • Being an athlete: The risk of having a rotator cuff injury is greater in athletes who regularly use repetitive motions, such as baseball pitchers, archers and tennis players.
  • Having poor posture: A muscle or tendon could become pinched under the shoulder bones due to poor posture.
  • Age: The risk of a rotator cuff injury increases as a person gets older. In people older than 40, rotator cuff tears are most common.
  • Working in the construction trades: The risk of injury increases in carpenters and painters, who also use repetitive motions.

Complications

Complications:

Not available

Treatments:

Exercise therapy is usually involved in the treatment of rotator cuff injuries. Specific exercises are designed to help provide balanced shoulder muscle strength, improve the flexibility of the rotator cuff and shoulder muscles, and heal the injury. The physical therapy may take from three weeks to several months, based on the severity of the injury.

Treatments for rotator cuff injury may include:

  • Surgery: The patient may need surgery to repair the tear in the case of having a large tear in the rotator cuff. A bone spur or calcium deposits may sometimes be removed during this kind of surgery. The surgery may be performed as an arthroscopic repair with the aid of a small camera inserted through a smaller incision, as a mini-open repair through a 3- to 5-centimeter (1 1/4- to 2-inch) incision or as an open repair through a 6- to 10-centimeter (2 1/2- to 4-inch) incision.
  • Arthroplasty: The development of rotator cuff arthropathy that can include severe arthritis may be led to by some long-standing rotator cuff tears over time. More extensive surgical options including total shoulder replacement (prosthetic arthroplasty) or partial shoulder replacement (hemiarthroplasty) may be discussed in these cases.
  • Steroid injections: Corticosteroid injection to relieve inflammation and pain may be used depending on the severity of the pain.


The use of a reverse ball-and-socket prosthesis is a unique treatment option that's available now. People who have very difficult shoulder problems, this reverse shoulder prosthesis can be most appropriate. These problems include having extensive rotator cuff tears and a failed previous shoulder joint replacement, or having arthritis in the joint, along with extensive tears of multiple muscles and tendons (rotator cuff) that support the shoulder.

Prognosis:

Not available

Expert's opinion

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