Rotator Cuff Injury
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Rotator Cuff Injury

(Rotator Cuff Tear; Impingement Syndrome)

En Español (Spanish Version)

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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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
  • Activities that involve repetitive overhead arm motion
  • Weakened shoulder muscles from inactivity

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, and perform a physical exam. The doctor will carefully examine your shoulder. You will be asked to move your shoulder in several directions.

Tests may include:

  • X-rays —to rule out fractures and bone spurs.
  • Arthrogram—dye is injected into the shoulder joint and then an x-ray or MRI is taken. The doctor will look for dye that leaks out of the joint, which may indicate a tendon tear.
  • MRI scan—a test that uses a strong magnetic field and radio waves to make pictures of the inside of the shoulder. This will show bones and tendons, and is an excellent way to determine either large or small tears of the cuff.
  • Arthroscopy—a thin, lighted tube is inserted through a small incision in the shoulder to look at the structures inside the shoulder. Arthroscopy can also be used for treatment.
  • Ultrasound—a test that uses sound waves to examine the rotator cuff for inflammation or tears.

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.
  • Corticosteroid injections—to help reduce swelling and pain.
  • 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 decrease inflammation and restore strength and motion to the shoulder area.

Surgical

Acromioplasty

This involves surgery on the bony structures that impinge the rotator cuff. It 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.

Open Surgery

This is used to repair the injured tendon 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 2 to 6 months, and sometimes longer.

Prevention

To reduce your chances of getting a rotator cuff injury:

  • Avoid overhead repetitive motion.
  • 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://www.orthosurgery.ubc.ca/index.html

References:

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

Azar FM. Canale: Campbell's Operative Orthopaedics . 10th ed. Philadelphia; Mosby; 2003. Ch. 44, 49.

Bowen JE, Malanga GA. Frontera: Essentials of Physical Medicine and Rehabilitation . 1st ed. Philadelphia; Hanley and Belfus; 2002. Ch. 16.

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

Malanga GA, Bowen JE. Frontera: Essentials of Physical Medicine and Rehabilitation . 1st ed. Philadelphia; Hanley and Belfus; 2002. Ch. 17.

National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/ .



Last reviewed January 2008 by John C. Keel, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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