Rotator Cuff Injury

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Rotator Cuff Injury

Definition

A rotator cuff injury is a tear or inflammation of the rotator cuff tendons in the shoulder.

Description

Rotator cuff injury is known by several names, including pitcher's shoulder, swimmer's shoulder, and tennis shoulder. As these names imply, the injury occurs most frequently in athletes practicing sports that require the arm to be moved over the head repeatedly, such as pitching, swimming, tennis, and weight lifting. Rotator cuff tendonitis is an inflammation of the shoulder tendons while a rotator cuff tear is a ripping of one or more of the tendons.

The tendons of four muscles make up the rotator cuff. The muscles are the supraspinatus, infraspinatus, teres minor, and subscapularis. The tendons attach the muscles to four shoulder bones: the shoulder blade (scapula), the upper arm bone (humerus), and the collarbone (clavicle.) The rotator cuff tendons can also degenerate due to age, usually starting around age 40. Rotator cuff injury may also be caused by falling on the outstretched arm or joint of the elbow. Either of these may produce enough force to drive the humerus into the shoulder socket.

Causes and symptoms

Some areas of the rotator cuff tendons have poor blood supply. Thus, the tissue is very slow to heal and maintain itself during normal use. Tearing and inflammation in athletes is usually due to hard and repetitive use, especially in baseball pitchers. In non-athletes over age 40, the injuries usually occur as a result of lifting heavy objects. The two primary symptoms are pain and weakness in the shoulder or arm, especially with arm movement or at night. A partial tear may cause pain but still allow normal arm movement. A complete tear usually leaves the injured person unable to raise the arm away from the side.

Diagnosis

Diagnosis is usually made after a physical examination, often by a sports medicine physician. X rays are also sometimes used in diagnosis as well as an arthrogram. However, the arthrogram is an invasive procedure and may be painful afterwards. For this reason, magnetic resonance imaging (MRI) is preferred to determine tendon tears as it also show greater detail than the arthrogram.

Treatment

The primary treatment is resting the shoulder and, for minor tears and inflammation, applying ice packs. Anti-inflammatory medications may also be prescribed. As soon as pain decreases, physical therapy is usually started to help regain normal motion. If pain persists after several weeks, the physician may inject cortisone into the affected area.

Serious tears to the rotator cuff tendons usually require surgery to repair. An instrument called an arthroscope is used to view the shoulder joint and confirm the presence of a tear. The arthroscope can also be used to remove any bone spurs that may be present in the shoulder area. Current arthroscopic procedures usually involve a 2 in (5.1 cm) incision in the outer shoulder. Through this incision the torn rotator edge may be reattached to the humerus with stitches.

Alternative treatment

There are no effective alternative medicine treatments for rotator cuff injuries.

Prognosis

The prognosis for recovery from minor rotator cuff injuries is excellent. For serious injuries, the prognosis is usually good, some six weeks of physical therapy being required following surgery. Full recovery may take several more months. In some cases, the injury is so severe that it requires tendon grafts and muscle transfers. In rare cases, a severe injury is not repairable, usually because the tendon has been torn for too long a time.

Prevention

The best prevention is to avoid repetitive overhead arm movements and to develop shoulder strength.

KEY TERMS

Arthrogram— A test done by injecting dye into the shoulder joint and then taking x-rays. Areas where the dye leaks out indicate a tear in the tendons.

Arthroscope— An instrument for the visual examination of the interior of a joint.

Arthroscopy— Examination of a joint with an arthroscope or joint surgery using an arthroscope.

Cortisone— A hormone produced naturally by the adrenal glands or made synthetically.

Magnetic resonance imaging (MRI) scan— A special radiological test that uses magnetic waves to create pictures of an area, including bones, muscles, and tendons.

Spur— Any projection from a bone.