What is your Rotator Cuff and why is it a Painful Topic?
Shoulder pain is very common and rotator cuff problems are a frequent source of that pain. We often take our shoulder movements for granted but issues in the shoulder can be very debilitating. They often cause us problems with simple daily activities such as washing, dressing, brushing our hair and even getting a good night’s sleep. If this sounds familiar, then please read on to find out how you can get the right rotator cuff support.
What is the rotator cuff?
Four muscles, known as the rotator cuff, attach to the shoulder blade and surround the ball and socket joint. Individually they rotate the shoulder in different positions but together as a team, their main job is to hold the ball in the socket. This provides stability and allows the bigger muscles to move the arm into various positions. Each of the muscles forms a tendon which attaches along the edge of the ball (head of the humerus bone) forming a single cuff of a tendon (hence the name rotator cuff).
What causes rotator cuff pain?
Disorders of the rotator cuff range from mild inflammation to a full-thickness tear of one or more of the tendons. The Most Common Cause of Rotator Cuff Tears: Not just an acute injury, but also due to chronic wear and tear from repetitive actions in certain sports and occupations such as tennis, swimming, golf, or heavy lifting jobs like plumbing, electrical work, and carpentry.
What are the symptoms?
Pain
Experience pain radiating from your shoulder to your upper arm during overhead activities or when reaching your hand to your back? This discomfort can also cause a general ache even at rest, and may even disrupt your sleep, especially if you roll onto the affected side
Weakness
This is usually due to a tear in the tendon but can also be secondary to pain caused by an inflamed tendon. With very large tears it may be very difficult to lift the arm at all; almost as if it is paralysed. This is called pseudoparalysis (false paralysis).
Clicking and cracking
Dysfunction of the rotator cuff tendons can lead to poor control of the ball in the socket of the shoulder which often causes clicking, popping or cracking when you move the shoulder. This can sometimes be painful.
What should you do if you think you have an injury?
If you think you may have a rotator cuff problem, you should speak to your GP as you will require further investigations to diagnose the problem. Following this, it is likely you will be referred to see a specialist shoulder surgeon to discuss the treatment options. The common shoulder investigations are:
Radiographs (X-rays) – This will show the bones of the shoulder and, although you can’t see the soft tissues clearly on x-ray, sometimes changes in the bone where the tendons attach can give an indication of problems with the tendons themselves. Any arthritis in the shoulder will also be detected with this investigation.
Ultrasound – This is a simple, non-invasive investigation, which is very good at looking at the rotator cuff tendons. It is very reliable at detecting inflammation, thickening and tears of the rotator cuff. Ultrasound can also be used to accurately give injections into the shoulder if indicated.
Magnetic Resonance Imaging (MRI) – This is a very reliable investigation which gives a clear view of the tissues in the shoulder including bones, cartilage, ligaments and tendons. The MRI not only identifies rotator cuff tears and inflammation but also determines the quality and level of retraction of the tendons. This helps determine which tears are repairable. Identify Shoulder Joint Arthritis with MRI Scans
What treatments are available for rotator cuff injuries?
Treatment depends on the severity of the injury.
Treat rotator cuff tendinosis with an injection to reduce inflammation and follow up with physiotherapy to strengthen the rotator cuff muscles and prevent the recurrence of inflammation.
In the case of a rotator cuff tendon tear, surgical intervention is more likely. However, not all patients need surgery. Up to 50% of people over the age of 60 will have chronic tears and no symptoms at all. Unfortunately, these tears never heal and if symptoms are affecting daily life and sleep then treatment will often be required. If the tear is small, strengthening the remaining tendons with physio may improve symptoms, but often the weakness never fully improves. A steroid injection may help improve the associated inflammation but will not repair the tear. With bigger tears, surgery is often indicated. This involves keyhole surgery to repair the tendon back to the bone using small anchors.
What are the consequences if I don’t get treatment for my rotator cuff problem?
Large, retracted rotator cuff tears can be difficult to repair. If the tendon has been torn for a long period of time (many months or years) and the tendon quality is poor, the surgeon may be unable to repair it. The rotator cuff tendons play an important role in stabilising the ball within the socket of the shoulder joint. Tears over a long period of time can, therefore, lead to arthritis in the shoulder. In both scenarios, keyhole surgery is unlikely to successfully improve symptoms. In these cases, a shoulder replacement may be the best option to get rid of patients’ pain and improve function.
If you are experiencing symptoms of a rotator cuff injury it is important you seek medical advice soon, especially if you have had an acute injury to prevent less severe injuries from getting worse. Get Rotator Cuff Support.