Shoulder pain is one of the commonest problems in middle aged patients or in athletes who deal with overhead movements of the shoulder (eg swimmers and baseball players). One of the most common reason for shoulder pain is a problem with the rotator cuff.
Rotator Cuff Anatomy
A human shoulder is a ball and socket joint which is made up with 3 bones: bone of your upper arm (humerus), the collar bone (clavicle), and the shoulder blade (scapula).
The rotator cuff helps keep your arm in the shoulder socket. The various muscles and tendons in the area form a covering near the top of the humerus and keep it attached to the shoulder blade.
The rotator cuff muscles slide under the bone called the acromion and if there is a bone spur arising from the acromion, it can irritate the rotator cuff, eventually leading to inflammation and tears.
Description of the Rotator Cuff
The rotator cuff consists of 4 muscles and tendons which hold onto the head of the humerus, keeping it stabilized. The supraspinatus is the most commonly affected tendon.
Pain in the rotator cuff can be caused by:
The rotator cuff tendons can be irritated or damaged.
Inflammation of the bursa can lead to swelling. This increases the amount of fluid in the sac and causes pain.
During the process of raising your hands to shoulder level, the gap between your rotator cuff and acromion reduces. Your acromion can impinge (rub against) your tendon and bursa and cause irritation and pain.
Symptoms of the Rotator Cuff Pain
Patients mostly report rotator cuff pain in the front area of the shoulder. Pain and stiffness may be felt while lifting your arm and you may experience difficulty while taking off your shirt. Lowering your arm from a raised position may also cause some pain. This is more common in middle-aged people as well as in young athletes. Swimmers, baseball players and tennis players are more vulnerable to this pain as they use their arms over shoulder levels during their sports. People whose jobs require repetitive lifting or overhead activities (painting, construction, paper hanging) are also at risk. Pain may also be a result of rotator cuff tears, which usually require surgery.
Initial symptoms are usually not severe and many patients avoid treatment during initial stage. The initial symptoms are:
• Minor pain while at rest as well as during any activity
• Pain that radiates from front region of shoulder down to the side of your arm
• Sudden pain felt in shoulder area during any lifting or reaching movements
• In athletes, pain while throwing or while serving the tennis ball
As the problem progresses, the symptoms increase:
- Pain at night
- Loss of strength and motion
- Difficulty doing activities that place the arm behind the back, such as buttoning or zipping up