Shoulder Injury: Rotator Cuff, New Delhi, India
Shoulder Injury: Rotator Cuff, New Delhi, India
Inflammation of or injury to the rotator cuff is one of the most common causes of shoulder pain which affects around 20% of the population.
Rotator Cuff: The role of the rotator cuff is to stabilise the shoulder joint, a ball and socket joint allowing the arm to have a wide range of movement. There are three bones making up the shoulder region:
Humerus:upper arm
Clavicle:collar bone
Scapula:shoulder blade, a triangular shaped bone that has two important parts to it: the acromion and the glenoid
These bones meet at two joints:
Acromioclavicular:between the acromion of the scapula and the clavicle.
Glenohumeral:between the glenoid of the scapula and the humerus.
The four muscles making up the rotator cuff are:
Subscapularis
Supraspinatus
Infraspinatus
Teres minor
Apart from muscles supporting the shoulder joint, there are also tendons which link bone to muscle and ligaments, linking bone to bone. The rotator cuff tendon attaches to the head of the humerus and passes through the gap between the shoulder blade and the acromion.
3 Main types of Injury
ROTATOR CUFF TENDONITIS
Probably the most common reason for pain in the shoulder is inflammation of the rotator cuff tendons. The pain can come on quite suddenly, possibly as a result of a recent injury, for example lifting something too heavy or weights incorrectly, or from overuse, for example, too much tennis in a week or lots of overhead painting. Sometimes there are deposits of calcium on the tendons due to long standing inflammation.
The pain will be most acute when you try to raise your arm above shoulder height, so reaching for something or pulling on a jumper could cause problems whereas writing or typing won't.
ROTATOR CUFF IMPINGEMENT
If the tendon gets trapped in the subacromial space (mentioned above), it is referred to impingement. The tendon is repeatedly scraped against the shoulder blade leading to a fraying of the tendon, leaving it wide open to tears. Caused through wear and tear, generally, and could lead to arthritis. The pain tends to be more gradual and longstanding.
ROTATOR CUFF TEAR
Most likely a tear to the tendons, but could also be to one of the muscles. In the young, probably the result of a trauma; in the older person, more likely to arise from impingement. The tear could be partial or complete and the pain is mostly felt on the front and outside of the shoulder, sometimes down the arm and often accompanied by a feeling of weakness in the shoulder. Range of movement is limited.
Causes
Repetitive overhead motion: Swimming, tennis, painting and decorating, weightlifting
Muscle imbalances: Some muscles may be stronger or weaker than others due to poor training methods or poor posture.
Lifting or pulling: If the object or weight is too heavy or if the action is executed incorrectly, then injury can occur.
Breaking a fall: Landing on an outstretched arm to break a fall can result in a tear or strain.
Wear and tear: There is an increased risk of injury once you get over 40, simply because the tendons start to wear down and unless you are doing something to prevent it, muscles become weaker.
Treatment
You need a diagnosis. Your doctor may be able to define the exact problem from a discussion with you and an examination, otherwise an Xray or MRI scan may be needed. The type of treatment you require will depend on the nature of the injury, but the following may help:
Rest: 48 hours of complete rest, avoiding any movements that cause you pain. Thereafter, gentle movement is encouraged to prevent stiffness or a frozen shoulder.
Ice packs: Wrap a bag of ice or frozen peas in a tea towel and place against the shoulder for 10 minutes at a time to reduce inflammation.
Anti inflammatory medication: Something like ibuprofen will help reduce inflammation and pain, but ensure you take as directed, usually 2 pills, 3 times a day, for 48 hour period, whilst you are resting.
Exercises:As soon as you can, you will need to start work on strengthening and stretching the area to aid full recovery and prevent a recurrence.
Steroid injections: Your doctor may recommend an injection if the above treatment fails.
Surgery:50% of rotator cuff injuries are successfully managed using the first four methods of treatment. However, as a last resort, surgery may be required.
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