The shoulder is an elegant and complex piece of machinery. Its design allows us to reach and use our hands in many different positions. However, while the shoulder joint has great range of motion, it is not very stable. This makes the shoulder vulnerable to problems if any or if its parts aren’t in good working order.
A rotator cuff injury can cause a dull ache in the shoulder, which often worsens with use of the arm away from the body. Conditions of the rotator cuff are the most common cause of problems of the shoulder.
Rotator cuff injuries are common and increase with age. These may occur earlier in people who have jobs that require repeatedly performing overhead motions. Examples includes mainly sports person, painters and carpenters etc.
What is Rotator Cuff Tear Injury?
Your rotator cuff is a group of four muscles and tendons that stabilize your shoulder joint and let you lift and rotate your arms. Each of the four tendons connects a muscle originating on the shoulder blade (scapula) to part of the upper part of the arm bone (humerus). The names of these muscle-tendon components of the rotator cuff are:
- The supraspinatus which runs over the top of the ball of the shoulder joint (humeral head);
- The subscapularis which runs across the front of the humeral head; and
- The infraspinatus and the teres minor which run across the back of the humeral head.
There are two kinds of rotator cuff tears:
A partial tear is when one of the muscles that form the rotator cuff is frayed or damaged.
The other is a complete tear. That’s one that goes all the way through the tendon or pulls the tendon off the bone.
The extent of injury necessary to tear the cuff depends on the quality of the tendon. Young healthy rotator cuff tendon is almost impossible to tear. However, older, multiply injured, multiply injected tendons or tendons in a smoker may tear with no injury at all.
Tears in younger individuals are more likely to extend only part way through the tendon (partial thickness tears). Tears in older individuals are more likely to tear completely through the tendon (full thickness tears) and to involve multiple tendons.
Tears in the rotator cuff result from a combination of injury and weakening of the tendon from wear and tear, disuse, degeneration and repeated use of steroid (cortisone) injection, and smoking. People over the age of 40 who dislocate their shoulders are likely to have cuff tears. Those who have a cuff tear in one shoulder are likely to have similar problems in the opposite shoulder.
Symptoms:
You can’t always feel a torn rotator cuff. But in some cases, you might:
- Have trouble raising your arm
- Have weakness in your shoulder
- Feel pain when you move your arm in certain ways or lie on it
- Be unable to lift things like you normally do
- Hear clicking or popping when you move your arm
- Unable to even comb your hair
See your doctor if you have any of these signs. If you don’t do anything about a torn rotator cuff, you can have more serious problems over time. You can end up with a frozen shoulder or arthritis that is harder to treat.
Causes:
Several factors contribute to degenerative, or chronic, rotator cuff tears.
- Repeating the same shoulder motions again and again can stress your rotator cuff muscles and tendons. Baseball, tennis, rowing, and weightlifting are examples of sports activities that can put you at risk for overuse tears. Many jobs and routine chores like cleaning, mechanics etc can cause overuse tears, as well.
- As we get older, the blood supply in our rotator cuff tendons lessens. Without a good blood supply, the body’s natural ability to repair tendon damage is impaired. This can ultimately lead to a tendon tear.
- Aging can cause bone spurs (bone overgrowth). Often develop on the underside of the acromion bone. When we lift our arms, the spurs rub on the rotator cuff tendon. This condition is called shoulder impingement, and over time will weaken the tendon and make it more likely to tear.
- Keeping the arm in the same position for long periods, such as doing computer work or hairstyling
- Sleeping on the same arm each night
- Poor posture over many years and aging.
Rotator Cuff Inflammation:
This friction is known as impingement syndrome and causes inflammation in the rotator cuff. Rotator cuff friction is most likely to cause inflammation if your shoulder movement is rough or repetitive. Inflammation can cause three problems:
- Rotator cuff tendonitis— Inflammation of a single tendon causes pain only during specific movements, when the muscle that pulls against that tendon is being used or when you are reaching upwards.
- Shoulder bursitis, also called subacromial bursitis — Bursitis occurs when inflammation spreads into the pocket of fluid that lubricates the rotator cuff tendons. Pain is often worse at night and occurs when you move your shoulder in almost any direction, particularly if you are reaching upwards.
- Rotator cuff tear— The tendon may tear after it has been weakened by inflammation.
Prevention:
If you are at risk of rotator cuff injuries or if you’ve had a rotator cuff injury in the past, daily shoulder strengthening exercises can help prevent future injury.
Most people exercise the front muscles of the chest, shoulder and upper arm, but it is equally important to strengthen the muscles in the back of the shoulder and around the shoulder blade to optimize shoulder muscle balance. Visiting doctor or a physical therapist at an early stage can help you plan a right exercise routine.
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