The rotator cuff of the shoulder is made of four muscles that attach onto the humerous from the scapula, (the shoulder blade). Their main purpose is to stabilize the shoulder joint and scapula and help you move your arm at the shoulder joint. This group of muscles is often injured at its insertion on the arm where they join together. Cuff tears are the most common shoulder disease in patients with shoulder problems and is prevalent in 21% of the general population and estimated to affect 50% of people over 50 years old. These statistics make cuff injuries a very common presentation in my office.
Rotator Cuff Tendinitis and Tears
A Tendinitis injury is due to overuse of the muscle, repetitive micro injuries, or secondary to trauma. The junction of the muscle tendon to the humerous bone gets inflamed and irritated causing stiffness, pain, loss of joint motion, and joint crepitus.
There are two types of rotator cuff tears: full thickness and a partial thickness tear. A partial tear occurs when one of the muscle is partially torn and a full thickness tear occurs when a tear occurs through the whole muscle attachment or it gets pulled off of the bone. Acute tears most commonly are caused when a fall occurs with an outstretched arm, and the ball of the humerous forcefully stretches the rotator cuff. Chronic tears come from repetitive actions like throwing a ball, rotation of the arm, and overhead work that can cause fraying and damage to the muscle overtime. Often inactivity and age leads to muscle wasting and the odds of injury increases.
Symptoms of a Cuff Injury
Symptoms of a rotator cuff injury include:
1. Trouble lifting your arm forward or to the side
2. Give away weakness when using the arm
3. Pain around the shoulder joint, mainly on the side
4. Clicking or popping when moving your arm
5. Trouble sleeping on your shoulder
6. Pain stretching your arm across your chest
7. Acute pain and swelling
A thorough physical exam involving muscle testing, range of motion testing, and examination of your neck and mid-back will be performed. The doctor is looking for weakness, muscle activation pain, decreased range of motion, and muscle tenderness. Another common symptom is the impingement sign. This occurs when tissue is pinched between the ball of the humerus and the roof of the shoulder joint. A pinching feeling occurs when lifting your arm to 90 degrees. The cuff muscle is responsible for helping the ball of the humerus move through the shoulder socket. When the cuff is damaged or inflamed, there is an improper movement pattern and an impingement occurs.
If an exam reveals suspicion of a tear, diagnostic imaging is needed. Ultrasound can be used to compare both shoulders but most often an MRI is the test of choice.
Treatment of a rotator cuff injury always starts with managing the inflammation and irritation at the injury site. The use of ice and anti-inflammatory medication is your first line of treatment. The second goal is to regain proper range of motion of the joint and thirdly strength work is needed.
Conservative, manual therapy is appropriate for partial tears or tendonopathies of the rotator cuff. Conservative care with the use of manual therapies including massage, ultrasound, current, acupuncture, chiropractic care, and strength training. The proper stretches and exercises will be given so that you can decrease inflammation and gain proper movement back. Rotator cuff injuries can result in compensatory movement patterns where the muscle of the neck and mid back are engaged to help move the shoulder. This results in neck and back pain that can be treated with chiropractic care.
Sometimes your medical doctor might suggest a steroid injection to help reduce chronic inflammation. This is often suggested if the injury is interfering with sleep and causing a lot of pain. The research shows that often injections provide temporary relief and should be used conservatively as they can contribute to weakening of the tendon.
Full thickness tears and some partial tears require surgery. There are three main surgical procedures including: open repair, arthroscopic repair, and mini-open repair. The choice of surgery largely depends on degree of the tear and the structural integrity of the joint. Your surgeon will discuss what option is best for you.
Surgery is usually a quick procedure and you will be home the same day.
The rotator cuff is a common muscle group to get injured. Overuse or trauma can cause damage to the muscles and result in a lot of shoulder pain. If you are worried about a rotator cuff injury, visit our office for an evaluation and a receive a treatment plan that will help your shoulder. We will be able to determine if you need a surgical consult or if you are a candidate for conservative care.
Activity fact: Factors that increase your chances of having a rotator cuff tear include: being male, having a job that requires repetitive physical work, age and if you have arthritis in your shoulder. Get active and keep your shoulders strong to avoid injury!!