Rotator Cuff Injury What is a Rotator Cuff injury? The Shoulder is one of the most complicated joints in the body (Figure 1). It is a ball and socket joint with a large range of movement. A group of muscles and their tendons called the rotator cuff help to keep the joint in place and help you to move your arm. There is also a small joint on the top of your shoulder which forms the end of your collar bone as it meets your acromion (end of your shoulder blade). Figure 1: Anatomy of the Shoulder The tendons run under the acromion where they are very vulnerable to being irritated. This can lead to a tear, either as a result of an injury or a tear can develop gradually. If the tendons or muscles of the rotator cuff tear, you may not be able to lift or rotate your arm as easily as before, and may experience significant pain when you move the shoulder. The pain is common at night, often spreading down the arm. As people age, it is normal for the rotator cuff tendons in the shoulder to suffer from wear and tear and degenerate. The rotator cuff becomes weak and can more susceptible to a tear. A fall or wrenching injury can then result in complete rupture of the tendons. This leads to pain and weakness of the shoulder. Around one third of us over the age of 40 have a rotator cuff tear and the risk increases with age. These degenerative tears can be treated without surgery. However, a traumatic tear that results from an injury can need surgery. The sooner a repair is dealt with through surgery, the better the shoulder will heal. Therefore, it is important to identify a traumatic tear quickly. You will need to see your doctor if you are over 40 years of age and you have had fall or wrenching injury and the pain and weakness is not settling within three weeks.
Figure 2: Rotator Cuff injury What can I do to help myself to get better? Small cuff tears or strain can get better within a few days or weeks. The following may help you in the first few weeks: Getting the balance right between rest and activity: When you have been diagnosed with a rotator cuff tear it is important to keep a balance between rest and activity. Try to change or adapt any movements that might be causing your pain or making it worse, such as repetitive movements overhead for example avoid painting the ceiling. Exercises These simple exercises may be helpful, click on the link below: http://www.arthritisresearchuk.org/arthritis-information/conditions/shoulder- pain/shoulder-pain-exercises.aspx They can be useful to ease pain and maintain the movement in your shoulder. If your pain increases when exercising, stop and rest for a few days. When your shoulder pain has got better, try to keep up exercising to stay strong and mobile. At home /work - Here are some tips to help you day to day Use a trolley or a backpack to carry shopping, or divide the weight between two bags and carry one in each hand. A bag with ‘cross the shoulder’ straps can reduce the load on your shoulder. Don’t spend so much time looking at tablets / computers and mobile phones. Use a stand for the device and place it on a table to reduce neck strain. If you use the phone a lot, don’t trap the phone between your head and your shoulder. Try a headset instead. When doing DIY (such as painting and cleaning the walls or ceiling) try to pace yourself and take regular breaks. Switch tasks and positions to reduce the load on your shoulder. Painkillers: Over the counter painkillers may be helpful such as paracetamol, ibuprofen or creams that you can buy at the chemist. Your pharmacist will be able to give you expert advice. Need to make these sections consistent.
Sleeping: Your shoulder may be painful to lie on. Try to lie on your good side and use a folded pillow to support your painful arm in front of your body. If you prefer to sleep on your back, use one or two pillows under your painful arm to support it off the bed. Hot and cold packs can be helpful to ease pain Cold / Ice packs or frozen peas can be particularly helpful in the first 48 hours after an injury or if your shoulder feels hot. Wrap the ice pack in a damp towel first before putting onto your skin to avoid a burn. Heat packs can help to ease shoulder pain if your muscles feel tense or sore. You can use a hot-water bottle wrapped in a towel, reusable heat pads from the chemist or a microwaveable wheat bag. How long will it take to get better? Small cuff tears or muscle strains can get better within a few days or weeks. If you are concerned after a fall or injury, you should see your doctor as soon as possible. You may need further investigations to see if it is a traumatic rotator cuff tear. After an injury the pain and loss of function can last longer than six weeks and sometimes even a few months to get better fully. Once the initial pain has settled, it may take many months before you can sleep on the painful side or use your arm overhead. It is usually not a problem to use the arm for activities such as writing or typing. As we get older there may also be some long standing weakness in the shoulder especially when reaching high overhead or playing sport. How can a clinician help? If your shoulder is not getting better after six weeks or the pain is severe you should see your doctor. Your doctor may prescribe some stronger medication to help with the pain and inflammation. You may also be referred for Physiotherapy. Physiotherapy is very important to keep your shoulder moving and maintain your strength. You are usually given some very specific exercises to help your condition but without increasing your pain. It is important to keep exercising after your pain has improved to maintain good use of your arm. Steroid injection: If your shoulder/arm pain is still not improving you may be offered a steroid injection using a steroid and an anaesthetic. This can help to reduce the inflammation and control the pain, which allows you to strengthen and use your arm. It is not advised to have repeated injections for a rotator cuff problem as this may weaken the tendons further. Surgery: An operationmay be required if 1. If the tear follows an injury as explained above 2. When pain and weakness is not improved with physiotherapy and possibly an injection. The goal of rotator cuff surgery is to relieve your pain and improve the shoulder strength. A rotator cuff repair involves stitching the torn tendon back onto its attachment to the humerus (arm bone).
This may be carried out either through keyhole surgery (Arthroscopy ) or open Surgery. Some tears are too large to repair and are known as 'Massive Cuff Tears'. These can be managed with a graded exercise programme.