Rotator Cuff is a group of tendons and muscles found at the shoulder. They attach the shoulder bones to the shoulder joint, therefore helping with free movement and keeping the shoulder stable. Rotator cuff problems are also called pitcher’s shoulder, swimmer’s shoulder, tennis shoulder, rotator cuff tendinitis or shoulder impingement syndrome.
The two main problems that affect the rotator cuff are – rotator cuff tendinitis and rotator cuff tear. The former is an inflammation of the tendon linings and irritation of the tendons. The latter happens when a tendon gets torn due to injury or overuse.
The main reasons for rotator cuff tendinitis are – keeping the arm in one position for long periods while working, sleeping on one arm the entire night, playing various sports that require the arms to be moved repeatedly, painters or carpenters who work with arms held overhead, age that leads to wear and tear of tendons and poor posture, lack of coordination and control of the muscles of the shoulder blades.
There are two types of rotator cuff tears – partial when the tear is not complete and parts of the tendons are still attached to the bones, and complete tear that detaches fully and usually will not completely heal. Rotator cuff tears occur because of a sudden fall with arms outstretched, sudden jerky movements when you lift a heavy object or a chronic tear that takes place slowly and overtime. The chronic tear occurs when a person has chronic tendinitis.
Rotator Cuff Tendinitis symptoms
Shoulder pain: Rotator cuff symptoms for those with tendinitis are predominantly shoulder pain. This is localized on the upper or outer arm and tip of the shoulder. It can radiate to the sides of the arms but never reaches the elbow. If it does go beyond to the hand and elbow this is an indication of a pinched nerve. There is no external evidence of inflammation but the pain can get aggravated by reaching for objects, pulling, pushing, lifting the arm above the level of your shoulder or lying on the shoulder. You can experience pain when brushing your hair, putting on clothes etc. Pain will also be felt when you lower your hand from the raised position. The pain can at times be so severe that it will prevent you from having a comfortable sleep or wake you up if you roll on to the painful shoulder by mistake.
When the pain becomes very severe, even trying to reach your back can be difficult. Rotator cuff tendinitis could also happen when other adjacent muscles or tendons get inflamed – e.g. bicep muscle. Some patients may even experience neck pain since these muscles can be used to compensate for pain in the shoulder muscles.
Rotator cuff tear symptoms
Weakness and pain at the shoulders are rotator cuff symptoms when the tendons tear. Some people may experience no symptoms at all. The pain is not directly related to the type of tear. Some patients can experience severe pain with a partial tear while others may experience no pain or weakness with a complete tear.
Some people with tears can experience a popping sensation upon any shoulder movement. People over 40 are more at risk of tendon tears. Even in this group, the elderly suffer rotator cuff tears due to impingement syndrome while in younger people it will be due to some accident or sports injury.
The exact place where tears occur will be when a person suffers chronic tendinitis. Tendon tears are more painful at night. During the day, the pain is felt during certain movements. Some patients could suffer bruising on the upper arm or shoulder.
What to do?
Rotator cuff symptoms cannot be treated at home. Shoulder pain could also be indicative of more serious problems like heart attacks. Hence, do not dismiss the pain but consult a doctor at once.
Treatment of rotator cuff problems
Depending on the severity of pain and other considerations, the doctor could recommend simple remedies first. These conservative treatments could involve placing ice to reduce inflammation or resting the shoulder by avoiding strenuous activities
Doctors may order an MRI scan to rule out any tear in your rotator cuff muscles. An ultrasound test, special imaging tests like arthrography can also be done. Sometimes a contrast material could be injected into your shoulder and a CT scan, X-ray or MRI done after this. This is usually done when a tear is suspected.
You may be told to wear a sling and rest your shoulder for a few days if you have moderate or severe pain. Resistance exercises, strength training and lifting hands above shoulder level must be avoided.
When movement of the shoulder is possible without pain, the rotator cuff muscles will be strengthened with appropriate exercises. These restore strength and balance to these muscles and reduce pain with overhead activities. If the pain is very severe, then a corticosteroid injection will be given by your doctor.
In case of rotator cuff tears or chronic tendinitis, surgery maybe performed on the shoulder to remove excess bones. This gives space for the rotator cuff muscles to move freely therefore reducing the possibility of pinching when overhead arm movements are made.
Exercises for the rotator cuff muscles that doctors could recommend are external rotation and internal rotation exercises. Before performing exercises, you could be advised to use heat and light massage for the affected areas. This is a good way to get the muscles ready for a range of motion exercises.
Rotator cuff : Prevention and Precaution
Most people who suffer from rotator cuff symptoms (tendinitis) make a complete recovery after the appropriate treatment comprising medications, surgery, injections or physical therapy has been undergone. Strenuous activities must be curtailed until you are completely cured.
Those who have rotator cuff symptoms (tears) also recover well although their recovery is largely dependent on the size of the tear and the period the patient has had the tear, their age, level of shoulder movement before the injury etc.
Prevention usually involves avoiding repetitive movements overhead and developing the opposing muscles of the shoulder with appropriate exercises.