Rotator Cuff Injuries
Joe Fleming provides a quick guide to understanding how a rotator cuff works, what common rotator cuff injuries are, and how to treat them.
When it comes to the use of your arms, few bodily components play as big of a role as your rotator cuffs.
What is a Rotator Cuff?
The rotator cuff is one of the most important groups of tendons and muscles in your body. It is responsible for holding the head of your upper arm bone (humerus) in the shoulder socket (glenoid clavicle). It is called a "cuff" because it rises off the shoulder blade (scapula) and attaches to the head of the humerus forming a cuff.
The rotator cuff both stabilizes the shoulder as well as facilitates its wide range of motion including internal and external rotation and abduction, where the arm moves out and away from the trunk of the body.
Common Rotator Cuff Injuries
Unfortunately, because of the location in the body and the frequent use of the shoulder and arm, rotator cuff injuries can be quite common. People who perform overhead motions in their sport or their job are most at risk for developing rotator cuff injuries; think baseball pitchers, painters, firefighters, volleyball players, swimmers, tennis players, carpenters, etc. Heavy lifting over a prolonged period can also lead to rotator cuff disease as can a sudden, substantial injury as you might sustain in a car accident or with a fall.
Researchers have additionally found genetic factors that might increase a person's risk of experiencing rotator cuff degeneration. Age also plays an important role (as the older you get, the higher your chances are of tearing your rotator cuff), and a 2010 study revealed that cigarette smoking increases the risk for rotator cuff tears.
Rotator cuff injuries can range from a little inflammation to full ruptures. Injuries may include:
Rotator Cuff Tendonitis
Tendons are tough, fibrous strands of tissue that connect muscle to bone. When the tendons of the rotator cuff become inflamed, they can end up rubbing against the shoulder blade instead of fluidly gliding against it. This friction can exacerbate swelling and cause dull aching pain, stiffness, and limited range of motion.
Torn Rotator Cuff
The tendons located at the end of the rotator cuff muscles can incur microscopic to full lateral tears either with a sudden traumatic injury or over time from long-term overuse. A torn rotator cuff can be both painful as well as severely restrict the movement of the arm. Research shows, however, that many cases of torn rotator cuffs are asymptomatic which means the tears, or lesions, or small enough to not "be felt" yet. This makes early diagnosis even more critical.
When the fluid-filled bursa sac that rests between the tip of the shoulder and the top of the arm bone becomes inflamed, it can cause friction and pinch with specific shoulder movements which results in pain. Normally the bursa sac protects the tendons of the rotator cuff, allowing them to glide and move smoothly when you use your shoulder. Everything from overuse to infection and even health conditions like arthritis and diabetes can contribute to bursitis.
Related to tendonitis and bursitis, shoulder impingement occurs when the inflamed tendons and bursa become so swollen that they severely narrow the space in the shoulder joint for movement and become pinched between the bones. This is known as impingement.
Diagnosing Rotator Cuff Injuries
In addition to a manual exam where your physician or sports medicine specialists evaluate your shoulder by touching it and having you move your arm, your doctor may also conduct imaging tests to get a better picture of what is going on inside.
X-rays, ultrasounds, and MRIs (magnetic resonance imaging) can all be used to help diagnose a rotator cuff injury and, in some cases, compare the structure of your injured shoulder to the structure of your uninjured one. If something like bursitis is suspected, the doctor may also aspirate, or remove fluid from, the swollen bursa to test for infection or other underlying conditions that could be causing your symptoms.
Treating Rotator Cuff Injuries
Treating rotator cuff injuries always begins with conservative measures like:
These methods can be combined with over-the-counter painkillers, supportive orthotic aids like shoulder braces, and steroid injections. Most often, recovery like this allows your body to heal the shoulder itself, reducing inflammation and repairing tissue to prevent the need for any surgery.
Recovery of full and safe use of the shoulder requires physical therapy exercises starting with low-intensity assistive passive exercises, like shoulder rotations, and working up to active exercises like resistance training which further strengthen the arm, reduce pain, and improve range of motion.
Physical therapists might employ tools like lightweight dumbbells, barbells, resistance bands, weights, and cable crossovers. Simple movements like raising the arms above your head, moving them out away from your body, and rotating them in tight circles will help target shoulder-related muscle groups to restore flexibility and strength. The end goal is ultimately to be able to exercise without the assistance of a physical therapist and, of course, without any pain.
In severe rotator cuff injuries, surgical intervention is the only route that will successfully repair the shoulder. Depending on the type of injury, surgeons may reattach a damaged tendon to your bone, replace a badly damaged tendon with another one from nearby, or administer a total shoulder replacement with an artificial joint.
Full recovery from a shoulder injury depends on the severity and type of injury as well as how it is treated, i.e. with or without surgery. Rehabilitation can take anywhere from a couple of months to a year, which seems lengthy, but as the shoulder is one of the most crucial joints in the body, it is worth it.
Preventing Rotator Cuff Injuries
To guard your shoulder against rotator cuff injuries, experts recommend simple steps like warming up before exercise, taking breaks during repetitive overhead motions, stretching your arms and shoulders regularly, and doing slow, controlled low resistance exercises. Early diagnosis can help you prevent making an existing injury worse so if you suspect rotator cuff damage or inflammation, go see your doctor for an evaluation.
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About the Author
Joe Fleming is the President at ViveHealth.com. Passionate about healthy lifestyles and living a full life, he enjoys sharing and expressing these interests through his writing. To inspire others and fight ageism, Joe writes to help people of all backgrounds and ages overcome life's challenges. His work ranges from articles on wellness, holistic health, and ageing to social narratives, motivational pieces, and news stories. For Joe, helping others is vital.