Rotator Cuff Injuries

Written by Giovanni Bruno

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What is a Rotator Cuff Injury?

A rotator cuff injury is a lesion addressed directly to one specific muscle group, the rotator cuff. The rotator cuff is a muscle group composed of 4 muscles: the supraspinatus muscle, the infraspinatus muscle, the teres minor muscle and the subscapularis muscle. Generally it can be said that the rotator cuff is a large muscular tendinous group which manages rotational movements of the shoulder joint. All the muscles are attached to the humerus bone.

All of the rotator cuff components can be injured, however the most commonly affected muscle is the supraspinatus. That is because, anatomically, it is the most subjected to mechanical force (for example the supraspinatus is responsible for stabilizing the shoulder during sport movements such as throwing a ball while playing baseball or doing a serve while playing tennis). All the rotator cuff muscles are involved in the stabilisation of your shoulder, specifically they keep the “ball”, the end part of the humerus, stable inside the socket joint (a cavity called the glenoid fossa).

What are the symptoms of a Rotator Cuff Injury?

The signs and symptoms of rotator cuff injuries are strictly related to the site of the injury and which muscle is or are involved; typically one of the major symptoms is the pain associated with a restriction or a loss of the shoulder range of motion. Some rotator cuff injuries do not provoke pain, so you may not feel pain at all, but you may feel uneasy when doing certain movements, especially reaching your back with your shoulder or doing movements over head.

Another of the symptoms of a rotator cuff injury is a feeling of weakness in your arm. This is because your affected tendon/s is/are not able to sustain your shoulder like before. Furthermore, you may experience some cracking-clicking sound coming from your shoulder during movements over head.

What are the common causes of a Rotator Cuff Injury ?

There are different type of injuries which may cause a tear in your rotator cuff such as a fall on an outstretched hand or an overuse caused by repetitive actions, but usually the main causes are always linked to a trauma or to a degenerative process caused by aging or by a continuous mechanical stress to your shoulder.

Repetitive motions that are likely to increase the risk of a rotator cuff tear are: weightlifting, rowing and sport motions such as serving in tennis and throwing in baseball.

As a generalization young people are more likely to injure themselves due to a trauma (dislocation, fracture) compared to the elderly or athletic population tend to develop a degenerative type of injury.

The aging degeneration process is linked to different factors such as the reduction of blood supply to the joints. Reduced blood supply can slow down the body’s self healing process leading ultimately to tendon tears. Another cause of lesion or inflammation of the rotator cuff in the elederly is the presence of bone spurs; bone spurs are the result of bone overgrowth due to the aging process; they usually develop under the acromion bone. And as a result can cause rubbing of the tendons during lifting motions of the shoulder. This can cause lesions and inflammation of the tendons.

How is Rotator Cuff Injury diagnosed ?

The diagnosis of a rotator cuff tear is made through a physical examination performed by your GP or your healthcare provider. During the appointment you will be asked to do some general and specific motions of your shoulder, together with specific orthopaedic tests, aimed to verify any lesion inside your joints or muscles.

According to the findings your GP or healthcare provider may prescribe you further diagnostic imaging such as X ray, MRI or ultrasound scan. The X ray examination is useful to see your bone profile and check if there are any bone alterations, such as bone spurs. MRI and ultrasound examinations give information on the status of soft tissues, including muscles, tendons and ligaments.

What are the treatment options for Rotator Cuff Injuries ?

The treatment options for a Rotator Cuff Injury can be divided into two types: conservative treatment (non surgical) and non-conservative treatment (surgical).

Conservative treatment includes the use of painkiller medication and antiinflammatory medications (such as ibuprofen, naproxen, aspirin) to help reduce the pain and control the inflammation.

Physical therapy such as physiotherapy is used to help strengthen specific muscle groups. This aids in increasing shoulder joint stability. Manual therapy such as osteopathy can also be used to help reduce muscle tension, improve posture and decrease overloads on your muscles and joints. Ice and heat packs may also be recommended to you to use. These help to reduce muscle tension and inflammation.

Another type conservative treatment is the use of cortisone injection, this strong medication typically reduces pain and inflammation. However it does not treat the cause of the problem.

There is no treatment that certainly works better than the other, the choice of treatment used will be based on your symptoms. Usually a combination of medication and physical or manual therapy represents the best conservative management for a rotator cuff tear.

Non conservative treatment is based on surgery and is usually the last option, in cases where previous conservative treatment has failed. Surgical intervention is usually performed when the tear in the muscles of the shoulder is complete and the fibers are no longer attached to the bone. In this case the tendons won’t likely heal on their own and a reconstruction surgery is needed.

Surgical intervention is decided according to the age of the patient, for example elderly people are less likely to be advised for surgical intervention compared to young athletes who can’t avoid certain repetitive movements.

There are different surgical techniques used based on the severity of the lesion, the most common types of surgery used for a Rotator Cuff Injury are: arthroscopy or open repair.
To repair a rotator cuff your orthopaedic surgeon will re-attach your tendons to the bones through stitches or suture anchors which are often used to help attach the tendon to the bone.

How long does a Rotator Cuff Injury last?

The recovery and healing process varies according to the presence of a complete or partial tear. A partial tear takes 2 – 4 weeks to heal, this time is not fixed and may change according to your daily motions and if rehabilitation and strengthening exercises are adhered to. A complete tear can take anywhere from 6 months up to 1 year to heal completely.

What are the best exercises for Rotator Cuff Injury*?

A good rehab plan for your shoulder is based on a combination of stretching and strengthening exercises aimed at improving range of motion and flexibility.
Below are examples of some exercises which may be useful in increasing the strength and stability of the shoulder joint.

Front shoulder stretch: Start in standing position and hold the sides of a doorway with each hand, remember to keep your hand below the line of your shoulders. Lean forward across the doorway until you feel a stretch in the front of your shoulder and in your pectoralis muscle. Repeat 5 times holding the stretch for 15 seconds. Do it once a day for 3 to 4 times a week.

External rotation on side lying position: Lie on the opposite side of your injured arm.
Bend the elbow of your injured arm to 90 degrees and rest the elbow on your side. Your forearm should rest across your abdomen. Hold a light- weight in the injured side’s hand.Keep your elbow attached to your side, slowly lift your arm up toward the ceiling.
Before putting your arm down, keep it high for 2-3 seconds and then release it.
Repeat 3 sets of 12-25 repetitions once a day, 3 to 4 times per week.

Reverse fly: Stand with your feet shoulder-width apart and your knees slightly bent. Keep your back straight and bend forward slightly at the waist. Hold in each hand a light dumbbell, extend your arms upwards away from your body. Your elbow should be slightly bent. Squeeze your shoulder blade as you extend your arms. Do not lift your arms higher than shoulder height. Repeat 3 sets of 12-15 repetitions, 3 to 4 times per week.

Pendulum swing: Start in a standing position to the side of a table or a chair. Gently lean forward without rounding your upper body and allow the affected arm to hang freely. Gently move the affected arm back and forward.You can also do small circles with your arm (clockwise and anticlockwise) or move it side to side.
Repeat the exercise 10 times per motion once a day 3-4 times a week.

*It is always recommended to get the go ahead from your GP or physical therapist before carrying out any of the exercises.

Do I need to see my local GP or go to the hospital?

You should see your GP if over the counter medication, ice, heat, rest and exercises did not work. In that case your GP may prescribe you stronger treatments such cortisone injection, further diagnostic examinations such as X ray or an MRI or may suggest you to go see a manual or physical therapist (massage therapist, physiotherapist, osteopath etc.)

In case of an acute injury or real severe pain you may also go straight to your local hospital and be assessed for excluding any type of lesions or underlying conditions.

References:

Baumer, T.G., Chan, D., Mende, V., Dischler, J., Zauel, R., van Holsbeeck, M., Siegal, D.S., Divine, G., Moutzouros, V. and Bey, M.J., 2016. Effects of rotator cuff pathology and physical therapy on in vivo shoulder motion and clinical outcomes in patients with a symptomatic full-thickness rotator cuff tear. Orthopaedic journal of sports medicine, 4(9)

Karasuyama, M., Gotoh, M., Tahara, K., Kawakami, J., Madokoro, K., Nagamatsu, T., Imai, T., Harada, N., Kudo, Y. and Shiba, N., 2020. Clinical results of conservative management in patients with full-thickness rotator cuff tear: a meta-analysis. Clinics in Shoulder and Elbow, 23(2), p.86.

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