Rotator cuff injuries affect patients of all ages, but the condition often goes undiagnosed and untreated.
The rotator cuff is composed of four muscles (and their affiliated tendons) that attach the scapula to the humerus (upper arm bone). Essentially, this tissue structure covers the shoulder joint and allows you to lift and rotate your arm.
Rotator cuff tears are common in older patients and their frequency increases with age. In fact, about 1 in 4 people ages 60 and above has some degree of rotator cuff injury. Active patients under age 50 also experience a high frequency of problems in this area. However, many of these patients don’t recognize the severity of their condition and consequently do not seek treatment.
Causes of Rotator Cuff Injuries
The wear and tear of daily arm use is the most common cause of shoulder injury. Rotator cuff tears can also occur due to severe trauma, such as falls, dislocations, and accidents. This type of tear is more common in the younger population. Jobs requiring repetitive movement (such as painting or window cleaning) contribute to this problem, as do playing certain sports, including basketball, baseball, swimming and tennis.
Symptoms & Diagnosis of Rotator Cuff Tears
In an acute rotator cuff injury, you may feel a popping or snapping in the joint, followed by intense pain and an immediate weakness or loss of use. In this case, patients recognize a problem and seek treatment immediately.
Chronic onset is less obvious, so patients often don’t seek treatment until the problem has progressed significantly.
Depending on the severity, pain can range from mild to severe, but range of motion is almost always compromised. Aching or pain at the front of the shoulder and upper arm are common. Overhead movement often increases the pain, as does sleeping on the affected side. Joint stiffness and arm weakness are also common symptoms.
To accurately diagnose the problem, the doctor must rule out other types of shoulder injuries, including tendinopathy, arthritis, fractures and bursitis, because these conditions may all present with similar symptoms.
The doctor will start by taking a medical history and learning more about your work, exercise and sports participation. Next, the doctor will examine your arm to determine the exact location of the pain and to gauge weakness and mobility.
The doctor will likely order imaging tests also, to help confirm your diagnosis. X-rays are the first step in evaluation, as it is necessary to rule out bone spurs and arthritis as causes. Ultrasound is helpful for assessing both muscles and tendons while in motion, and MRIs can provide a more detailed picture of soft tissues.
Treatment of Rotator Cuff Injuries
If the main complaint is pain and there is no history of trauma, the doctor will typically begin with a conservative treatment approach, recommending rest, ice and nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain. Corticosteroid injections may be recommended if the pain persists. The doctor may also prescribe a course of physical therapy to help restore strength and flexibility to the shoulder.
If the main complaint is motion or if there is a history of trauma, it is more likely that advanced imaging, such as an MRI, will be ordered.
Many patients experience a significant reduction in pain and discomfort from conservative treatment. However, if a tendon is torn or damaged, the injury cannot heal on its own. For patients with diagnosed tears and persistent pain and inability to use the arm, surgery may be necessary, using arthroscopic or an open surgical approaches.
To determine the best course of action for your shoulder injury, schedule a consultation with a shoulder specialist at the Center of Orthopedic & Rehabilitation Excellence (CORE). We have shoulder specialists in our Riverton, West Jordan and West Valley City, Utah, locations. Contact us today to discuss your shoulder pain and potential rotator cuff injury.