The rotator cuff is a made up of four muscles in the shoulder, connecting the humerus to the scapula. The rotator cuff tendons provide stability to the shoulder; The muscles allow the shoulder to rotate. A rotator cuff injury can cause a dull ache in the shoulder, which usually worsens when you try to sleep on the affected side.
Rotator cuff injuries most often in people who frequently perform overhead activities in their jobs or sports. The risk factor of rotator cuff injury further increases with age. Many individuals will recover from rotator cuff tears with physical therapy exercises that will improve the strength and flexibility of the muscles throughout the shoulder joint.
Rotator cuff includes four muscles:
Supraspinatus
Infraspinatus
Subscapularis
Teres minor
Each muscle of the rotator cuff inserts at the scapula and has a tendon that attaches to the humerus. The tendons and other tissues together form a cuff around the humerus.
Symptoms of a Rotator Cuff Tear
- Pain at rest and at night, concretely if lying on the affected shoulder Pain in lifting and lowering your arm or with specific forms of movements.
- Weakness in lifting and rotating of the arm.
- Crepitus or crackling sensation when moving the shoulder in certain positions.
- Snapping sensation and immediate weakness in the upper arm.
Causes of a Rotator Cuff Tear
There are two main causes of rotator cuff tears are -Injury and Degeneration.
Acute Tear of Rotator Cuff Muscles
Fall down on the outstretched arm or lift something too heavy with a jerking movement. This type of tear may occur with other shoulder injuries, such as broken collarbone or dislocated shoulder.
Degenerative Tear of Rotator Cuff Muscles
Most tears are the result of wearing down of the tendon that occurs gradually over time. This degeneration naturally occurs as we age. Rotator cuff tears are more in the dominant arm. If you have a degenerative tear in one shoulder, there is a more preponderant risk for a rotator cuff tear in the other shoulder — even have no pain in that shoulder. Several factors contribute to chronic rotator cuff tears-
Repetitive stress- Repeating the same shoulder forms of movements, again and again, can stress rotator cuff muscles and tendons. Baseball, rowing, tennis, and weightlifting are examples of sports that can put at risk for overuse tears.
Lack of blood supply- As we get older, the blood supply in rotator cuff tendons lessens. Without a good blood supply, the body’s natural ability to rehabilitate tendon damage is impaired. This can ultimately lead tendon tear.
Bone spurs- As we age, bone spurs often develop on the underside of acromion bone. When we lift arms, the spurs rub on rotator cuff tendon. This condition is also known as shoulder impingement, and over time will weaken the tendon and make it more liable to tear.
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Risk Factors of a Rotator Cuff Tear
Because most rotator cuff tears are largely caused by normal wear and tear that goes along with aging, people over 40 are at more preponderant risk.
People who do repetitive lifting or overhead activities are also at risk for rotator cuff tears. Athletes are especially vulnerable susceptible to overuse tears, categorically tennis players and baseball pitchers. Painters, carpenters, and others who do overhead work additionally have a more preponderant chance of tears.
Although overuse tears caused by sports activity or overhead work additionally occur in younger people, most tears in adults are caused by a traumatic injury, like a fall.
Diagnosis of a Rotator Cuff Tear
Your physicians will suspect a rotator cuff tear predicated on your clinical history and findings from a series of clinical tests.
A diagnostic ultrasound scan is the most precise method to diagnose the size and location of the rotator cuff tear. MRI’s may show a rotator cuff tear but have additionally been known to miss a tear. X-rays have little diagnostic value when a rotator cuff tear is suspected.
Rotator cuff Physical examination-
Supraspinatus-
Patient position standing or sitting upright position. The arm should be anteriorly flexed at the shoulder level with the pronated arm. The patient should resist downward pressure applied to the forearm by the examiner. If pain or weakness that indicates supraspinatus tear.
Supraspinatus & Infraspinatus-
Patient position standing or sitting upright position with affected arm adducted(slight abduct) and elbow flexed. If failure to maintain an active full external rotation that indicates a supraspinatus & infraspinatus tear.
Subscapularis tear-
Patient position standing with affected arm against the stomach with elbow anterior to the midaxillary line. The patient is asked to press the belly. Failure to maintain the elbow anterior to the mid-axillary line while pressing against the belly indicates subscapularis tendon tear.
Neer’s test-
Patient position standing or sitting upright position. The examiner will passively elevate the pronated arm of the patient above the level of the shoulder.
Pain at the anterolateral aspect of the shoulder indicates subacromial impingement.
Hawkin’s test-
Patient position standing or sitting upright position with arm fully adducted & forwardly flexed. The elbow is flexed.
The examiner will place one hand on the patient shoulder and apply internal rotation to the affected arm with the other hand.
Pain at the shoulder indicates subacromial impingement.
Drop arm test-
Patient position standing or sitting upright position. The patient is asked to hold the affected arm in abduction at the level of the shoulder then smoothly adduct the arm.
A patient suffering from rotator cuff tear will not be able to hold the arm in abduction and the arm will drop rapidly.
Treatment of a Rotator Cuff Tear
Initial treatment of rotator cuff tendinitis involves managing pain and swelling to promote healing. This can be done by:
Avoiding activities that cause pain.- Applying cold packs to your shoulder three to four times per day.
- Taking non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen.
Additional treatment may include:
Physical Therapy-
Your physicians may refer you to a physical therapist. Physical therapy will initially consist of stretching and other passive exercises to avail renovate range of kineticism and facilitate pain. Once the pain is under control, your physical therapist will teach you exercises to avail regain strength in arm and shoulder.
Steroids-
If rotator cuff tendinitis is not being managed by more conservative treatment, your physicians may recommend a steroid injection. This is injected to the tendon to reduce inflammation, which reduces pain.
Surgery:
If nonsurgical treatment isn’t successful, your doctor may recommend surgery.
Home Care for Your Shoulder:
There are several things you can do to avail reduce pain from rotator cuff tendinitis. These techniques can additionally avail obviate rotator cuff tendinitis or another flare-up of pain.
Self-care for Shoulder includes:
- Using good posture while sitting.
- Taking breaks from perpetual activities.
- Avoiding lifting arms repetitively over your head.
- Avoid carrying a bag on one shoulder.
- Avoid sleep on the same side every night.
- Carrying things close to your body.