The rotator cuff is a frequent source of pain in the shoulder.
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 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
The physcial examination will look for areas of tenderness and the range of motion of the shoulder. We will assess the strength and integrity of the rotator cuff and also examine the neck, which can be a source of referred pain to the shoulder.
Other tests which may help us confirm your diagnosis include:
Normal x-rays are not very helpful here as they do not show your shoulder’s soft tissues such as the rotator cuff. They will either show a normal image or small bone spur even for an injured shoulder with rotator cuff pain.
This is why a special type of x-ray view is used for diagnosis. This view, known as “outlet view” sometimes shows a small bone spur in the image on the front edge of your acromion.
Magnetic resonance imaging (MRI) and ultrasound
MRI and ultrasound are much better alternatives for assessing soft tissues such as the rotator cuff.
For most, the initial methods to treat these injuries are non-surgical; this can take weeks, or even months, but the gradual improvement will help people regain motion and return to fully functional movements over time.
Modification of motion, including eliminating or limiting overhead reaching, and similar activities, might be suggested by your doctor, in addition to resting the area.
Non-steroidal anti-inflammatory medicines
Medicines like ibuprofen or naproxen are also prescribed to aid in lessening swelling and helping reduce pain levels.
Initially, the goal will be to restore full mobility to the shoulder area; many stretching exercises can be used to improve the range of motion. Difficulty reaching behind the back is generally a sign of posterior capsule (inner lining of your shoulder, towards the back) tightness, and specific stretching motions can help in relieving the pain you experience in the area. Once pain is lessened, you and your therapist can begin working on strengthening of the rotator cuff muscles.
When physical therapy, rest, and medication for pain aren’t doing the trick, an injection of cortisone, a powerful anti-inflammatory medication, may be required. It will be injected into the bursa, directly below the acromion, and this relieves pain and inflammation in the rotator cuff quickly.
If non surgical methods aren’t working, then surgery might be suggested. A main goal of surgery is to provide additional room for the rotator cuff’s motion, as well as to treat the underlying reason for the pain, such as a tear in the cuff.
This is done by removing the inflamed portion of the bursa. An anterior acromioplasty may also be performed, where a part of the acromion bone spur will be removed (known as a subacromial decompression).We do this arthroscopically (keyhole surgery).
In arthroscopy, instruments are are inserted via two or three small holes, around your shoulder. A fiberoptic scope is attached to a small TV, so the shoulder can be examined during the procedure. A video monitor guides the small tools used, and soft tissue and bone are then removed.
Most cases require removal of the front edge of the acromion as well as tissue from the bursa area. If necessary, other issues can be treated during the procedure. These can include arthritis between the clavicle (collarbone) and the acromion (acromioclavicular arthritis), inflammation of the biceps tendon (biceps tendonitis), or a rotator cuff tear.
Post surgery, you might have your arm placed in a sling to help in the healing process. As soon as you are comfortable enough, the sling is removed, and exercises can ensue to help strengthen the area. Based on the specific surgical findings, the programme will be tailored to your specific needs.
Exercises will be done to help regain motion and help strengthen the arm. It generally takes about 3 months to achieve complete pain relief, although in certain cases it can take up to a year.