What Is The Rotator Cuff Injury?
The shoulder’s flexibility is due to its unique structure. Like the hip, the shoulder is a “ball-and-socket” joint – a “ball” at the top of the upper arm bone (the humerus) fits neatly into a “socket” formed by the shoulder blade (scapula). But unlike hip joints, where the ball sits in a deep, well-protected socket, the shoulder socket is very shallow. As a result, the shoulder is the most frequently dislocated major joint in the body. It’s also prone to a variety of other injuries and chronic problems that can be painful and hinder a person’s ability to perform ordinary tasks.
The rotator cuff is a group of muscles closely wrapped around the shoulder (see bottom picture). These muscles help to keep the joint in the correct position and control shoulder movements. They attach onto the shoulder blade and the top of the long bone of the arm (humerus) and pass through a narrow space within the joint underneath the point of the shoulder (acromion), called the subacromial space. A small fluid lining (bursa) cushions the tendon against compression from the point of the shoulder (acromion). The tendon can be damaged through general wear and tear, long term impingement or after an accident/fall. The damage usually occurs close to where the muscle inserts to the bone (tendon). If one or more or these tendons is torn, movement is no longer smoothly controlled and the shoulder becomes weak and painful.
Shoulder Impingement or Rotator Cuff Tear?
If a rotator cuff tendon becomes inflamed or is partially torn, it can cause pain and limit shoulder movement. If a tendon tears completely, the corresponding muscle can no longer affect movement of the arm. This type of injury usually causes severe limitations in shoulder movement as a result of pain and weakness.
The most common cause of rotator cuff injury problems is a disorder known as impingement where the subacromial space is inadequate to allow the normal smooth gliding movements of the rotator cuff as it moves the arm. Every time the arm is raised, the rotator cuff is pinched due to this smaller than normal space.
In other cases, impingement is caused by accident or injury. Most often, it occurs with aging. As people grow older, their shoulder muscles and tendons weaken, causing the shoulder joint to become less stable. The space between the upper arm and the acromion narrows. The rotator cuff has less room to move. The increased pressure gradually damages the rotator cuff.
Although the rotator cuff can tear suddenly as a result of a serious injury, most rotator cuff problems develop over time. Over a period of months or years, the rotator cuff tendon and its overlying bursa can become inflamed and swollen due to impingement, causing the rotator cuff to become irritated, to tear partially, or to tear completely.
Signs and Symptoms
Symptoms of a rotator cuff tear are often mild at first and worsen overtime. Common symptoms include pain at night and pain that worsen with activities, particularly when using your arm over your head (e.g. painting, tennis). These symptoms are similar to those of tendinitis or bursitis (inflammation of the bursa), but these conditions often get better with rest, modification of activities, and anti-inflammatory medications (eg asprin, ibuprofen). Symptoms of rotator cuff tears may not get better with the usual treatment.
In addition to pain, your arm and shoulder may feel weak when you use your arm over your head or out to the side of your body.
Do I Need Surgery?
Rotator cuff tears do not heal well with time. The body needs blood to heal itself, but there are few blood vessels that supply the rotator cuff, and consequently most rotator cuff injuries heal slowly. Rotator cuff tears tend to either enlarge, or, at best, stabilize in size. That said, the first step in rotator cuff treatment is usually with conservative measures. While the size of the tear may not change with conservative treatment, the symptoms often diminish. Most people, including those who have a partially torn tendon, can be treated successfully without surgery. The most serious type of rotator cuff injury, a completely torn tendon, can sometimes regain enough strength and flexibility to function with conservative measures but usually requires surgery in order to heal completely.
Your physiotherapist will have a primary role in the conservative management of a rotator cuff injury. If the injury is severe enough to warrant surgery, discussion with your therapist will be required to determine whether a referral to a specialist is necessary. Post operative physiotherapy will the then be the main focus in the rehabilitation process if surgery eventuates.
Non-surgical treatment will depend on the severity of the rotator cuff injury and the differing signs and symptoms you present with. The varying degrees of injuries can often be successfully treated with an aim to relieve the inflammation and irritation of the rotator cuff tendons and the bursa over the tendons. This can be achieved through resting and icing your shoulder, taking anti-inflammatory medications, ultrasound, mobilizations, strengthening and range of motion exercises, postural education and trigger point therapy.
If symptoms persist, occasionally the doctor may inject cortisone (a strong anti-inflammatory medication) in the bursa to decrease inflammation and pain. When the inflammation is under control or has decreased significantly, more intense physiotherapy techniques can commence. Post surgical patients will require a long term program to increase and regain strength, stability, and range of movement to their shoulder, through a closely monitored step by step program.
How Long Is the Recovery From Rotator Cuff Repair Surgery?
This will depend on several factors, including your level of strength before the operation and the severity of the rotator cuff tear. Some period of immobilization of the shoulder joint is needed to protect the newly placed sutures from being disrupted.
After one to two weeks, physio begins. Initially, the therapy is gentle so as not to affect the rotator cuff repair. After four to six weeks, more active movement and exercise begins. Several months after the rotator cuff repair, physiotherapy will become more intense in an effort to strengthen the rotator cuff muscles. Complete recovery usually requires at least four to six months.
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