Rotator Cuff Injuries
Rotator cuff Injuries
The Rotator Cuffs are a group of muscles and tendons that surround the shoulder joint providing stability. They are called the Subscapularis, Supraspinatus, Infraspinatus and Teres minor and ara all small muscles situated around the shoulder joint. They help keep the humerus (upper arm bone) deep into the socket. The stability of the shoulder joint is therefore provided by the rotator cuff muscles as well as the joint capsule and ligaments.
Even though their job is to provide stability they all have individual actions aiding in movement every time you move your arm.
A rotator cuff injury is when you have injured one or more of the muscles or tendons through overuse or from trauma. This can cause inflammation that may start with tendonitis or if higher trauma/injury may present as or may tear in the muscles and tendons. If you have injured the rotator cuffs you may find that you have difficulty in lifting your arm forward, upward and sideways
What causes a rotator cuff Injury?
The Rotator cuff injury can be mild and severe depending on how it was injured. can be injured from overuse such as doing the same action or activity repeatably that over time causes irritation. This can progress and can then impact your movement and become very painful lifting your arm or trying to use it.
Trauma can also cause an injury and this may be from an action such as lifting, throwing or falling and may cause a muscle or tendon tear.
the 3 main causes for micro trauma to the rotator cuffs are:
Primary Impingement is when the rotator cuffs are compressed/impinged in what is known as the subacromial space. This is a small space under the acromion ( shelf of the shoulder) and the humerus. Some of us will naturally have a small space but the space can reduce in time due to postural changes and arthritic changes
Secondary Impingement is due to more of a muscular and biomechanical imbalance that is causing impingement of the rotator cuff tendon in the subacromial space. This can be due to having increased laxity in the shoulder joint. Over time due to repetitive overhead activity, poor posture or inactivity the tissues can get irritated and inflamed. As this impingement is not due to a small subacromial space it is referred to as secondary.
Overuse/Overstress. This is where we have done a forceful action like tennis serving, throwing a ball. IN these tasks the rotator cuff muscles are under high load and if these actions are repeated many times we can then cause irritation to the the tissues causing inflammation.
What are the Symptoms of a rotator cuff tear?
Symptoms of a Rotator Cuff injury can be reduced movement, weakness and pain around the shoulder. The pain can be at the front, side or back.
Movements such as bringing the arm out to the side, stretching behind or lifting it upward such as any overhead activities can be impacted. For example, it may be painful trying to reach a cupboard or putting your seat belt on. It is also common to feel pain in bed especially in lying on that side.
What Treatments can I do?
Initially, after any injury, we want to help reduce discomfort and protect the area. But we want to also keep it moving as much as we can within our pain limits.
Non-surgical treatments can include nonsteroidal anti-inflammatory drugs ( NSAIDS), short-term oral corticosteroids, corticosteroid injections, physiotherapy and acupuncture,
Physiotherapy can be beneficial in restoring movement and regaining strength again helping the shoulder function more optimally. This can be combined with manual therapy that has shown to be effective in the early stages. graduated loading and rehabilitation is used to optimise to healing,
Corticosteroid injections have been shown to reduce pain, increase movement and improve function especially when there is significant pain and reduced movement. However, this should be discussed with your physician if it is the most suitable for treatment at that time.
Surgical treatment options for patients who have rotator cuff tears that won't repair. This should be discussed with the consultant and after all other conservative options have been undertaken demonstrating no improvement,