Rotator Cuff Injuries | Orthopaedics and Sports Medicine | Dartmouth-Hitchcock
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Rotator Cuff Injuries

Alternative names: Rotator Cuff Impingement, Bursitis, Tendonitis, Tennis Shoulder, Partial or Complete Tear of the Rotator Cuff

What is a rotator cuff injury?

Rotator cuff injuries are among the most common and painful shoulder-related injuries in adults, especially in people who exercise a lot. The rotator cuff (or musculotendinous cuff) in the shoulder is made up of tendons and muscles covering the shoulder joint. The rotator cuff helps to keep the shoulder in place and also works to lift and move the shoulder.

Rotator cuff injuries are seen as a range from an impingement – a common example of a rotator cuff injury, which occurs when the shoulder blade rubs or 'impinges' on the rotator cuff when the arm is lifted – through a complete tear. The rubbing of the rotator cuff can cause injuries in the mid range, such as tendonitis, bursitis (inflammation of the bursa, which covers the rotator cuff), or a partial tear.

What are the signs of rotator cuff injury?

Rotator cuff injuries are linked to limiting of movement of the shoulder and a dull ache in the upper arm and shoulder. At first the pain is mild but can become stronger over time.

Symptoms include:

  • Shoulder pain when lifting or sleeping
  • Inability to move the shoulder as much as normal
  • Sudden pain when lifting or reaching with the shoulder
  • Swelling or tenderness in the front of the shoulder
  • Weakness of the shoulder

What causes a rotator cuff injury?

Rotator cuff injuries are common in people who lift their arms a lot, especially in athletes and in workers with heavy lifting duties. Causes include:

  • Arm movements in swimming, baseball, tennis and other sports
  • Arm movements in heavy lifting, painting, and construction

How does my doctor tell if I have a rotator cuff injury?

The doctor will take some of the following steps to see if a patient has a rotator cuff injury:

  • Ask the patient about the cause of any injury or previous history of this condition
  • Do a physical exam of the shoulder to check mobility and pain in movement
  • Request an X-ray to help in diagnosis
  • Arrange for an MRI (magnetic resonance image) to get a clearer picture of the problem

Non-surgical treatments

There are several non-surgical treatment options that may help stop the pain. The first is to simply rest the shoulder to give it time to heal. The physician may prescribe an oral medication to decrease the inflammation.

Physicians may recommend physical therapy in which patients are given a series of lifting and stretching exercises to strengthen the shoulder and increase range of motion. Physical therapy can take several months.

Steroid injections in the shoulder may be suggested. This treatment may help to reduce inflammation and pain.

Surgical treatments

If non-surgical treatment options do not work, a doctor may recommend surgery. The purpose of surgery is to remove or shave down the bone that is rubbing on the rotator cuff or to repair a torn rotator cuff.

Shoulder arthroscopy

This small cut technique allows surgeons to examine and repair the shoulder using tiny cameras and tools through small incisions (cuts) in the shoulder. The surgeon will use the little camera called an arthroscope to examine the rotator cuff and shoulder. If necessary, the surgeon will then use tiny tools to remove tissue and/or bone, or will repair tears.

Open surgery

Surgeons make a small incision (cut) in the shoulder. This surgery is used when more of the bone and tissue needs to be removed. Sometimes open surgery is used to fix other problems in the shoulder including a type of arthritis (acromioclavicular arthritis).

Post-surgery recovery

After surgery the arm is placed in a sling to reduce mobility and give the shoulder time to heal. Once the shoulder is healed enough the sling can be removed. The physician may prescribe exercises or physical therapy depending on the type of surgery.

 

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