Injuries and Conditions: Shoulder: Rotator Cuff Injury: Medical Details
Overview The shoulder is a complex and unique joint. Although it provides the most range of motion of any joint in the body, it also has the least stability. The muscles which support and stabilize the shoulder literally hold the joint together. Like the hip, the shoulder is formed from a ball and socket design, but the socket is much more shallow in the shoulder. The surrounding muscles, tendons and ligaments provide the additional necessary support for the joint. Any injuries to these structures, such as a rotator cuff injury, directly affect the stability and strength of the shoulder.
Rotator cuff injuries are categorized into four stages based on the severity of the injury.
Stage I: Swelling and Mild Pain
Stage II: Inflammation and Scarring
Stage III: Partial or Complete tears of the rotator cuff
Stage IV: Cuff tear arthropathy. This is severe shoulder arthritis from long-standing cuff disease.
Causes of Injury
Impingement occurs when the rotator cuff tendon rubs agains the acromion bone, as if a tire were rubbing against the fender because the fender was too close. This can cause the tendon to become inflamed.
Rotator cuff injuries can occur from a sudden violent movement of the shoulder, chronic repetitive motions, aging or overuse.
A rotator cuff tear occurs most commonly in patients in their mid-50's to late 60's and older.
Sports commonly associated with rotator cuff tears include tennis, swimming, baseball, softball and football.
Breaking a fall with your arms can cause bruising or even tearing in the tendons of the rotator cuff.
Lifting heavy objects overhead can stress or cause a tear in the rotator cuff.
Poor posture may cause a shoulder muscle or tendon to become pinched under the top of the shoulder (acromion) and result in impingement or tearing of the rotator cuff.
Diagnosis
A detailed history and physical exam should be conducted by an orthopaedic surgeon to confirm a rotator cuff tear. Rotator cuff tears, impingement syndrome, frozen shoulder, shoulder arthritis, nerve injury within the shoulder may present similar symptoms on initial examination. The physical exam may include movement and resistance tests that will help to determine your stability, flexibility and strength and the extent of the rotator cuff injury.
The clinical findings may indicate a rotator cuff tear, but to make an accurate and complete diagnosis, radiographic imaging studies may also be ordered. These tests will provide the physician with highly detailed views of the shoulder's muscles and tendons. Standard X-rays will be taken of the involved shoulder to evaluate the bones. An MRI (magnetic resonance imaging scan) may also be ordered. The images from the MRI will show if there is inflammation, tears, other conditions or injuries involving the muscles and tendons.
If a rotator cuff tear is confirmed, the physician will discuss surgical versus non-surgical treatment options. If the tear is complete, surgery is usually recommended in the young active patient. In patients over the age of 60 or with those who are have increased health risks, surgical treatment is suggested only after a careful assessment of the risks vs. the benefits of an operation.
Anatomy
Product Considerations
NSAIDs NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) are a group of drugs used to control pain. This category of medications includes both prescription and common over-the-counter painkillers such as ibuprofen. NSAIDs are effective for many types of pain that can occur because of inflammation of muscles, joints and bones. The drugs work quickly and people often notice some benefit within a few hours of taking the tablet. However, the complete effectiveness of the drug may not be realized for up to four weeks. For each individual, some varieties of NSAIDs are more effective than others. Often, patients will find that one or two varieties are helpful whereas others may not be as effective in controlling symptoms. It is usually necessary to try several brands and continue with the one that is most suitable. NSAIDs can be used to treat:
