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Shoulder & Elbows
Rotator Cuff Injuries —
The Shoulder's Most Common Disorder
You've probably read about baseball players
being sidelined with a torn rotator cuff. This painful shoulder
injury strikes a number of professional athletes, but it also
common among people who never find themselves on the playing
field. For those people, the injury occurs gradually while they're
performing far more mundane daily activities, such as combing
hair, reaching for dishes on top shelves and trimming tall bushes.
Most torn rotator cuffs are akin to wearing
out a fan belt. Four tendons make up the rotator cuff, which
anchors four large muscles from the shoulder blade to the upper
arm bone. It basically holds the shoulder together.
Without the rotator cuff, arm and shoulder
mobility would be severely limited, and it would be impossible
to move the arm in a 360-degree arc. The tendons are essential
for performing a variety of common tasks, from raising the arms
above the head to reaching across a desk to pick up a phone.
Repeated movement of the arms and shoulders
means that the rotator cuff tendons rub against the shoulder
muscles and often against a part of the shoulder bone known
as the acromion. Even sleeping with your head resting on an
outstretched arm pinches the rotator cuff under the cape of
the shoulder and wears it out.
Injuries to the rotator cuff generally occur
in one of two ways. Professional athletes weaken the rotator
cuffs by placing extra strain on the shoulders, and they don’t
have the luxury of taking time off to let the injuries heal.
A sudden movement can then rip the weakened cuff completely
from the bone. With the exception of professional athletes,
this kind of severe injury is very uncommon in people younger
than 35 years of age.
The majority of rotator cuff tears occur more
gradually, with a little rip here and there. The cuff is weakened
first by tendinitis, also sometimes called bursitis. Shoulder
tendinitis happens more often in people with loose joints, in
those with an abnormal bony anatomy in the shoulder and in people
who do heavy lifting above the shoulder level.
This condition can progress to a partial or
complete tear of the rotator cuff. For this reason, doctors
advise that patients pay attention to pain, swelling and weakness
of the shoulder and/or a limited range of arm and shoulder motion.
These are symptoms of an irritated rotator cuff.
The incidence of rotator cuff injuries increases
with age. Most people in their 70s and 80s have tears. Not everyone
knows it, however. Many rotator cuff tears are symptom-free
for years, until they suddenly flare up. That flare-up can be
caused by new stress on the joint or a traumatic injury.
Treatment of rotator cuff injuries varies depending
upon the severity of the tear and the age of the patient. Professional
athletes often head for the operating room where doctors surgically
reattach the torn tendons.
The surgery is often done arthroscopically.
Surgeons make a small incision at the shoulder, insert a tube
in to the shoulder joint and thread a miniature television camera
inside to view the tear. Tiny instruments are used to reattach
the tendon and to shave the shoulder bone, thereby reducing
friction against the rotator cuff. The operation generally takes
about an hour.
Patients who undergo surgery generally have
full use of their shoulder again in about three months, but
strenuous activities can be delayed far longer. Patients have
to work hard at regaining motion, power and endurance. Rehab
is a big issue with rotator cuff injuries, so surgery is only
part of it.
For the typical patient, doctors often try
to avoid surgery. They usually recommend packing the sore shoulder
in ice two or three times a day for 20 to 30 minutes. In addition,
limiting activities that strain the shoulder, such as lifting
weights and hitting tennis serves will help to keep the swelling
down. Doctors also prescribe nonsteroidal anti-inflammatory
drugs such as aspirin, ibuprofen and naproxen to control pain
and reduce swelling and soreness. This therapy does not repair
the tear, but allows the body time to compensate for the injury.
Physical therapy is also useful. Strengthening
the muscles helps improve mobility and flexibility, even through
the tendons may still be damaged.
Doctors diagnose rotator cuff injuries and
their severity with one of two tests. Magnetic resonance imaging
(MRI), a non-invasive procedure, is the most commonly used.
The other choice is an arthrogram, which involves injecting
dye into the shoulder joint and then viewing the rotator cuff
by x-ray.
Both tests have drawbacks. The arthrogram is
a simple way to detect a complete tear in the cuff, but if the
tear is on the top side of the rotator cuff, the dye doesn’t
come through to reveal partial tears there. The trouble with
MRIs is that they can be too good and make tiny tears look worse
than they are. MRIs are also very expensive.
Preventive measures include stretching before
exercising to maintain good flexibility and avoiding extreme
strain to the shoulder. There are no foods or vitamins that
will prevent rotator cuff tears.
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