Rotator Cuff Problems
DefinitionThe rotator cuff is a group of muscles and tendons that attach to the bones of the shoulder joint, allowing the shoulder to move and keeping it stable. Rotator cuff tendinitis refers to irritation of these tendons and inflammation of the bursa (a normally smooth layer) lining these tendons. A rotator cuff tear occurs when one of the tendons is torn from the bone from overuse or injury.
CausesThe shoulder joint is a ball and socket type joint. The top part of the arm bone (humerus) forms a joint with the shoulder blade (scapula). The rotator cuff holds the head of the humerus into the scapula. It also controls movement of the shoulder joint.
Tendinitis The tendons of the rotator cuff pass underneath a bony area on their way to attaching the top part of the arm bone. When these tendons become inflamed, they can become frayed over this area during shoulder movements.
Sometimes, a bone spur narrows the space even more. Rotator cuff tendinitis is also called impingement syndrome. Causes of this condition include:
Rotator cuff tears may occur in two ways: A sudden acute tear may happen when you fall on your arm while it is stretched out. Or it can occur after a sudden, jerking motion when you try to lift something heavy. A chronic tear of the rotator cuff tendon occurs slowly over time. It is more likely when you have chronic tendinitis or impingement syndrome. At some point, the tendon wears down and tears.
There are two types of rotator cuff tears: A partial tear occurs when a tear does not completely sever the attachments to the bone. A complete, full-thickness tear means that the tear goes all the way through the tendon. It may be as small as a pinpoint, or the tear may involve the entire tendon. With complete tears, the tendon has come off (detached) from where it was attached to the bone. This kind of tear does not heal on its own.
Early on, pain is mild and occurs with overhead activities and lifting your arm to the side. Activities include brushing your hair, reaching for objects on shelves, or playing an overhead sport. Pain is more likely in the front of the shoulder and may travel to the side of the arm. The pain always stops before the elbow. If the pain goes down the arm to the elbow and hand, this may indicate a pinched nerve in the neck. There may also be pain when you lower the shoulder from a raised position. Over time, there may be pain at rest or at night, such as when lying on the affected shoulder. You may have weakness and loss of motion when raising the arm above your head. Your shoulder can feel stiff with lifting or movement. It may become more difficult to place the arm behind your back.
Rotator Cuff Tears
The pain with a sudden tear after a fall or injury is usually intense. Right after the injury, you will likely have weakness of the shoulder and arm. It may be hard to move your shoulder or raise your arm above the shoulder. You may also feel snapping when trying to move the arm.
With a chronic tear, you often do not notice when it began. This is because symptoms of pain, weakness, and stiffness or loss of motion worsen slowly over time. Rotator cuff tendon tears often cause pain at night. The pain may even wake you.
During the day, the pain is more tolerable, and usually only hurts with certain movements.
Over time, the symptoms become much worse and are not relieved by medicines, rest, or exercise.
Exams and TestsA physical examination may reveal tenderness over the shoulder. Pain may occur when the shoulder is raised overhead. There is usually weakness of the shoulder when it is placed in certain positions. Xrays of the shoulder may show a bone spur or change in the position of the shoulder.
Your doctor may order other tests: An ultrasound test uses sound waves to create an image of the shoulder joint. It can show a tear in the rotator cuff.MRI of the shoulder may show swelling or a tear in the rotator cuff.
With a joint x-ray (arthrogram), the doctor injects contrast material (dye) into the shoulder joint. Then an x-ray, CT scan, or MRI scan is used to take a picture of it. Contrast is usually used when your doctor suspects a small rotator cuff tear.
TreatmentFollow your doctor's instructions on how to take care of your rotator cuff problem at home. Doing so can help relieve your symptoms so that you can return to sports or other activities.
Tendinitis Your doctor will likely advise you to rest your shoulder and avoid activities that cause pain. Other measures include: