Rotator cuff injury

[JOEYZ]

Rotator Cuff Problems
The rotator cuff is a group of 4 muscles that helps to lift your shoulder up over your head and also rotate it toward and away from your body. Unfortunately, it is also a group of muscles that is frequently injured by tears, tendonitis, impingement, bursitis, and strains. The major muscle that is usually involved is called the supraspinatus muscle.

Rotator Cuff Problems are usually broken up into the following categories - click on any of the categories to learn more about it. If you're not sure which one of these you have, start here.

Rotator Cuff Tendonitis. This is also known as Impingement Syndrome or Shoulder Bursitis. Usually this occurs in people 30-80 years of age, and usually the weakness in the shoulder is only mild to moderate. Click here to learn more. Rotator cuff tendonitis, also knows as "bursitis" or "impingement syndrome" occurs when the rotator cuff gets irritated on the undersurface of the acromion. The reason this begins in the first place is a source of some debate: Some people are born with a "hooked" acromion that will predispose them to this problem. Others have rotator cuff weakness that causes the humerus to ride up and pinch the cuff. This means that the bursa - a water-balloon type structure that acts as a cushion between the rotator cuff and acromion/humerus - gets inflamed. What are the symptoms of impingement syndrome?
Common symptoms of rotator cuff tendonitis include:
Pain - primarily on top and in the front of your shoulder. Sometimes you can have pain at the side of your shoulder. Usually is worse with any overhead activity (reaching up above the level of your shoulder).
Weakness - mild to moderate weakness, especially worse with overhead activity.
Popping - sometimes bursitis that occurs with rotator cuff tendonitis can cause a mild popping or crackling sensation in the shoulder
Unable to sleep on shoulder - most patients complain of difficulty sleeping on the shoulder at night. How is impingement syndrome diagnosed?
Often, the diagnosis is suggested by your symptoms. Your orthopaedic surgeon or primary care physician can have you perform various maneuvers to detect this problem. This physical examination is designed to test your motion, strength, and certain positions of pain. In addition, plain x-rays can show a spur on the undersurface of the acromion. An MRI is occasionally ordered if a rotator cuff tear is suspected.

How do we treat rotator cuff tendonitis?
Just about all orthopedic surgeons agree that this problem should be treated initially "conservatively" - that means without surgery. What are the steps to healing?


Stop any activities that can aggravate your symptoms. For example, if you're painting the ceiling in your garage and it's making your shoulder feel worse, stop doing it!
Do not ignore your body - it is telling you (with pain) that something is wrong.
Take medications, if necessary, to make you comfortable and decrease your pain.
Consider using cryotherapy (cold therapy) to get your pain under control.
STRENGTHEN your rotator cuff!
Why does strengthening the rotator cuff muscles work?
When you have this tendonitis you get into a "vicious cycle":

First your rotator cuff is irritated for various reasons (overuse, injury, etc).
Then it doesn't work as well - and that causes increased pressure under the acromion bone.
The only way the acromion can react to that is to make new bone (a bone spur!).
That bone spur then presses on the rotator cuff.
So the rotator cuff gets MORE irritated, and then more weak, and so on... (go back to step 1)

Strengthening your rotator cuff is the scientifically proven way to break this vicious cycle. Virtually all orthopaedic shoulder surgeons agree that exercise for the rotator cuff muscles (stretching and strengthening) is the most important first step in treating impingement syndrome/rotator cuff tendonitis/bursitis




Rotator Cuff Tear. This occurs usually in people who have had tendonitis for a while and are starting to experience more weakness. It can also happen in someone who tries to lift something too heavy and feels a pop in the shoulder. Click here to learn more. What is a rotator cuff tear?
A rotator cuff tear occurs when the tendonitis in the rotator cuff gets so bad that it wears a hole through the rotator cuff tendon. Since the tendon is what connects the rotator cuff muscle to your humerus bone, when the tendon is torn, you have weakness in the shoulder. Usually these tears occur in people who have had shoulder pain for some time (called a "chronic rotator cuff tear"). This is, by far, the most common type of rotator cuff tear.

However, tears sometimes happen in people who do not have a history of shoulder problems. These people try to lift something that is too heavy and feel a pop in their shoulder, usually with immediate pain (this is called an "acute rotator cuff tear").
What are the symptoms of a rotator cuff tear?
Rotator cuff tears usually cause the following symptoms:

Pain - primarily on top and in the front of your shoulder. Sometimes you can have pain at the side of your shoulder. Usually is worse with any overhead activity (reaching up above the level of your shoulder).
Weakness - moderate to severe weakness, especially worse with overhead activity. This weakness is worse than in those people with simple rotator cuff tendonitis. Often patients complain of inability to put dishes up in the cupboards. Some patients with tears cannot lift their arm up to do their hair or scratch their head.
Stiffness - many patients will experience stiffness in the shoulder. This happens because it either hurts to move the shoulder, or you simply cannot move it because you are too weak. This stiffness can be progressive - meaning that it can get worse with time. Sometimes, the stiffness and loss of motion alone can be the biggest problem!
Popping - sometimes bursitis that occurs with rotator cuff tears can cause a mild popping or crackling sensation in the shoulder. In addition, the tear itself may rub and can cause this sensation.
Unable to sleep on shoulder - most patients with tears of the rotator cuff complain of difficulty sleeping on the shoulder at night. How do you diagnose a rotator cuff tear?
Usually the diagnosis is made with an examination by your doctor. He or she can do special tests to determine how weak your rotator cuff muscles are. In addition, the doctor can check your motion to see if stiffness has developed.

X-rays can show bone spurs in people with rotator cuff tears. Often these bone spurs helped to create the tear.

Sometimes an MRI is ordered - this can show the doctor with great detail the rotator cuff tendon and where it is torn. If your doctor suspects a partial thickness tear (the tendon is not torn all the way through, just part of the way), an MR-arthrogram may be ordered - this involves an injection into your shoulder before the regular MRI.

The treatment of rotator cuff tears:
Treating the torn rotator cuff usually involves the following:


Control your pain. Over-the-counter medicines or prescription medication is given to help to relieve pain. In addition, cold therapy (cryotherapy) can help to decrease the pain and local swelling. Avoid activities that can worsen your pain - particularly overhead activities, repetitive motions, and heavy lifting. Do not put your arm in one position for a long time - keep it mobile. Your physician may give you a steroid injection into your shoulder area to also help improve the pain. Most orthopedic surgeons recommend that you get no more than one or two of these a year, as they do have the potential to weaken your tendons (every person is different, however - you should check with your doctor).
Regain motion. It is critical to regain the motion lost as a consequence of having this tear of the cuff muscle/tendon. Our deluxe shoulder therapy exercise set can help you in this process - it has pulleys and other devices that allow you to use your other arm to help the injured one. Regaining motion doesn't just improve your mobility, it can often decrease your pain as well!
Strengthen the other muscles of the rotator cuff that are not torn. These muscles can help to compensate for the torn muscle. Because their are 4 muscles in the rotator cuff, and usually only one is torn, sometimes strengthening the others is all you need to return to pain-free function. Our deluxe shoulder therapy set contains many useful devices of a rehabilitation program for the shoulder. These include professional quality Therabands, pulleys, a cane, and instruction book for shoulder exercises. We have found that those patients who do their exercises regularly at home, in addition to (or instead of) physical therapy, will have better overall return of function in their shoulder.
Sometimes, if all this fails to relieve your pain, rotator cuff repair surgery might be needed to re-attach the torn tendon. There are lots of pros and cons to surgery, and different people need surgery for different reasons - be sure to discuss this with your doctor. The bottom line is that not everyone with a rotator cuff tear needs surgery to feel better.

Instability Impingement. This occurs in younger patients, typically 15-30 years old. The rotator cuff is irritated because the shoulder is loose in the socket. This often happens in baseball pitchers, swimmers, and other throwing athletes. Shoulder instability, dislocation.
Shoulder instability can be classified into two different types, dislocations and subluxations.


Dislocations. This happens when the head of the humerus completely pops out of the socket. The first few times this happens, it is usually with significant trauma (although some people can have these without any injury at all). After that, it can get easier and easier for the joint to dislocate. Most shoulder dislocations are anterior - this means that the ball pops out the front of the socket.


Subluxations. This is the feeling that the shoulder slips slightly out of socket, then immediately comes back in place. This often happens without any major trauma. Sometimes it happens in people who are very "loose-jointed". Sometimes these happen in just one direction (like out the front - "anterior"), and other times they happen out multiple directions - (eg. front - anterior and back - posterior) - this is called "multidirectional instability". Shoulder Instability: Diagnosis
Most often, a diagnosis of recurrent shoulder dislocations can be made by simply listening to the patient's symptoms. These patients will come in stating that their shoulder pops out of socket, and either goes back in by itself, or has to be put back in by someone else. Sometimes, the tricky part is knowing which way the shoulder is coming out of the socket - it can come out the front ("anterior") or the back ("posterior") or both ("multidirectional"). Your doctor will usually order x-rays, and sometimes an MRI, to get a better idea of what is causing your dislocations (for example, a torn cartilage, loose ligaments, etc.).

Diagnosing subluxations can be more tricky. There are physical examination maneuvers that your doctor can perform to get a better idea if your shoulder is loose. Sometimes, however, it is not always clear - people with subluxations may not know their shoulder is subluxating - they may simply experience pain. An MRI can occasionally be helpful in this diagnosis.

Shoulder instability: Treatment
Most orthopedic surgeons will agree that treatment of most shoulder dislocations and subluxations should initially be conservative: that is, without surgery.

If this was your first dislocation, especially if you had an anterior shoulder dislocation, your doctor will usually recommend that you wear a shoulder sling for up to 3 weeks (depending on how old you are - be sure to follow your doctor's direction). Controlling your pain will be important - cryotherapy (see our PolarCare Cub) can be of great help in relieving pain and swelling.

Next, you need to regain motion if you have gotten stiff. Be sure to follow your doctor's instructions on when and how to do this. Our deluxe shoulder therapy kit is a great device to help you get your motion back.

Now comes the most important step: Strengthening your shoulder to prevent recurrent dislocations or subluxations:


Strengthening the rotator cuff muscles is the scientifically proven way to help reduce your chance of re-dislocating or subluxating your shoulder.
Because the rotator cuff muscles surround your shoulder, by strengthening them you help to improve the stability of the shoulder. Indeed, the muscles can sense when your shoulder is about to come out of socket and activate to try to prevent it.
Strengthening your shoulder is more than just going to the gym and doing military presses. Most exercises that body-builders perform do not strengthen the rotator cuff!
Our Deluxe Shoulder Therapy set comes with all the specialized equipment you need to regain your motion and strengthen your rotator cuff. The included manual will show you how to specifically strengthen the rotator cuff muscles to prevent recurrent dislocations. And, the best part is that it is very affordable and can be used in the comfort of your own home. In our experience, people who do their exercise at home, daily, will have the best chance of avoiding surgery!

[Naughty Nurse]

Another good one big guy!