The shoulder is the most mobile joint in the body, allowing for an extensive range of motion. However, this also makes it vulnerable to rotator cuff injury and a rotator cuff tear is the number one injury of the shoulder.
Rotator cuff tears, the most common cause of shoulder pain and disability in adults, are increasingly prevalent. They are the at the forefront of the shoulder issues that account for 4.5 million doctor visits annually in U.S.
There are several types and causes of rotator cuff tears. These include:
Partial tears. Also called incomplete tears, these are damaging but not completely severed tears of the tendon.
Complete tears. These are also called full-thickness tears, and they separate the tendon from the bone.
Acute tears. These are caused by accident or trauma, such as a fall or quick movement in lifting a heavy object. These tears can happen in conjunction with other injuries, such as a dislocated shoulder or broken collarbone.
Degenerative tears. Degeneration occurs naturally with age. Most rotator cuff tears are due to the wearing down over time of the tendon.
A number of factors predispose a person to a rotator cuff tear. These include the following:
Age. The risk of a rotator cuff injury increases with age. In fact, tears of the rotator cuff are most common in those over 40, and some experts estimate among those over age 70, 15 to 30 percent or more of them have rotator cuff tears.
Prior injury. People more prone to rotator cuff tears include those with a prior injury or a history of trauma to the area. Those with a degenerative tear in one rotator cuff are also at greater risk of a tear in the other shoulder.
Overuse. Those who engage in repeated overhead shoulder motions in sports such as baseball pitching, swimming, tennis and activities such as painting or hammering are more prone to this injury.
Shoulder arthritis. Arthritis of the shoulder makes people more prone to develop muscle weakness, shoulder instability and osteophytes (bony cysts), causing stress on the rotator cuff.
Symptoms of a rotator cuff tear, whether partial or complete, occur in the shoulder and can include any of the following below. However, this injury can also be present without any symptoms.
Pain. From severe to dull or achy; can also occur from reaching or movement overhead, lifting or sleeping on the injured side. Overhead activities (e.g. sports listed above) worsen the pain.
Weakness. Felt in the arm; can make daily tasks difficult, as well as sports or other activities that involve the injured side.
Instability. As above, shoulder or arm instability impacts performance and function.
Locking or catching. Felt in the shoulder; popping can also accompany this symptom.
As in other conditions, a diagnosis begins with a patient review of medical history and symptoms with the doctor.
The doctor will then perform a physical exam of the rotator cuff, testing the muscles, and will test with movements to determine instability or impingement. This exam can often determine the nature of the injury even without imaging (i.e. X-ray or MRI).
One specific physical test is the drop-arm test. The doctor will place the arm to a person’s side, and see if he/she can slowly lower the arm to the waist. If there is a rotator cuff tear, the arm will simply drop to one’s side.
In the event imaging is indicated in order to confirm the tear, the doctor may order the following:
X-rays. These can assist in detecting shoulder arthritis, impingement and any calcifications that have formed in the tendons. They can also reveal evidence of any prior shoulder injury.
Ultrasound. Ultrasound can reveal soft tissue injuries. Due to its real-time imaging, it also allows the doctor to examine a patient’s shoulder during specific movements and thereby narrow in on the problem.
MRI. An MRI gives a cross-sectional, detailed view of the shoulder, which is not available with X-rays or ultrasound.
Rotator cuff tears do not always require treatment, primarily if those tears do not cause symptoms. Treatment for symptomatic tears depends on the severity of the injury, the length of time of the injury, and on one’s age and general health.
Conservative treatments are usually adequate for the majority of those with rotator cuff tears. These may include:
- Ergonomic adjustments (e.g. computer keyboard and desk/chair height)
- Physical adjustments (posture, sitting, sleeping positions)
- Cold or heat treatments to the affected area
- Pain medications
- Physical therapy and/or strengthening and stability exercises
- Steroid injections
You don’t have to live with rotator cuff pain. Dr. Harris Shaikh can create a personalized pain management and treatment plan, including the treatments listed above. To schedule an appointment, contact Nova Spine & Pain Centers today.