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Rotator Cuff Injury

(Rotator Cuff Tear; Impingement Syndrome)

Definition

Rotator cuff injury may include tendinitis, strain, or tear of the rotator cuff. The rotator cuff is made up of muscles and four separate tendons that fuse together to surround the shoulder joint.
Rotator Cuff Injury
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Copyright © Nucleus Medical Media, Inc.

Causes

Causes of a rotator cuff injury include:
  • Direct blow to the shoulder area
  • Falling on an outstretched arm
  • Chronic degenerative wear and tear on the tendons:
    • Arthritis may decrease the space for the tendons
    • Chronic instability of the humerus may traumatize the tendons
  • Repetitive overhead motion of the arm such as in:
    • Swimming
    • Baseball (mainly pitching)
    • Tennis

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors for a rotator cuff injury include:
  • Age: 40 or older
  • Heavy lifting
  • Abnormalities of the shoulder, or in rotator cuff anatomy or function
  • Activities that involve repetitive overhead arm motion such as throwing or work related
  • Weakened shoulder muscles from inactivity or previous injury

Symptoms

  • Recurrent, constant pain, particularly when reaching overhead
  • Pain at night that prevents you from sleeping
  • Shoulder muscle weakness, especially when lifting the arm
  • Popping or clicking sounds when the shoulder is moved
  • Limited range of motion in the shoulder joint

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. The doctor will carefully examine your shoulder. You will be asked to move your shoulder in several directions.
Tests may include:
  • Ultrasound
  • Arthrogram
  • MRI
  • Arthroscopy

Treatment

The treatment will depend on the extent of your injury, level of pain, and amount of immobility. The first step is usually a nonsurgical approach.

Nonsurgical

  • Rest—to help the shoulder heal. The doctor may recommend that you wear an arm sling to help rest the shoulder area.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)—to help control the pain if there is inflammation
  • Topical pain medicines (such as creams or patches) that are applied to the skin
  • Corticosteroid injections—to help reduce swelling and pain
  • Injection of platelet rich plasma (PRP) to reduce bleeding
  • Ice—to help reduce swelling and pain. Apply ice to shoulder area for 15 minutes, 3 to 4 times a day.
  • Physical therapy—to help strengthen and increase motion in the shoulder area

Surgical

Acromioplasty
This involves surgery on the bony structures that impinge the rotator cuff. Surgery can be arthroscopic or open.
Arthroscopy
A small instrument is inserted into the shoulder and used to remove bone spurs or degenerated portions of the rotator cuff tendons. Lesser tears can be repaired during arthroscopy as well.
Mini-Open Repair with Arthroscopy
This combines arthroscopy with an incision in the shoulder joint. Through the incision, the doctor can suture larger tears in the tendons or muscles.
Open Surgery
This is used to repair the injured tendon or muscle in more severe cases. A tissue transfer or a tendon graft can be done during surgery if the tear is too large to be closed together. In the most severe cases, a joint replacement may be necessary.

Recovery

Depending on the extent of your injury, full recovery can take anywhere from two to six months, and sometimes longer.
If you are diagnosed with a rotator cuff injury, follow your doctor's instructions.
If you are diagnosed with a rotator cuff injury, follow your doctor's instructions.

Prevention

To reduce your chances of getting a rotator cuff injury:
  • Avoid overhead repetitive motion
  • Limit duration of work that involves
    • Moving hands above shoulders
    • Using shoulder in extreme outward rotation
    • Vibrating tools
  • Avoid heavy lifting
  • Exercise regularly to strengthen the muscles around the shoulder joint

RESOURCES

American Academy of Orthopaedic Surgeons http://www.aaos.org

The American Orthopaedic Society for Sports Medicine http://www.sportsmed.org

CANADIAN RESOURCES

Canadian Orthopaedic Association http://www.coa-aco.org

The University of British Columbia Department of Orthopaedics http://orthopaedics.med.ubc.ca

References

Castricini R, et al. Platelet-rich plasma augmentation for arthroscopic rotator cuff repair: a randomized controlled trial. Am J Sports Med. 2011 Feb;39(2):258-65.

Deu RS. Common Sports Injuries: Upper Extremity Injuries. Clin Fam Pract. 2005 Jun; 7(2); 249-265.

Rotator cuff tear. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com. Updated May 28, 2012. Accessed October 23, 2012.

Smith MA, Smith WT. Rotator cuff tears: an overview. Orthop Nurs. 2010;29(5):319-322

10/26/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Massey T, Derry S, Moore R, McQuay H. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010;(6):CD007402.

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