Rotator cuff injuries are one of the most common sports injuries. The shoulder girdle is an incredibly complex collection of bones, muscles, and tendons that work together to allow us to lift, lower, and rotate our arms in their sockets. Whenever we raise up our children, carry groceries in from the car, or take a three-point shot, our rotator cuff comes into play. A rotator cuff injury can include tears or tendinitis, a condition in which the tendons of the rotator cuff become inflamed (also called impingement syndrome). It is important to understand the anatomy of this essential area of the body, along with causes of rotator cuff injury and potential treatments.
Shoulder anatomy 101
The shoulder girdle consists of three separate joints that provide the largest range of motion of any part of the body. These three joints are the glenohumeral joint, the acromioclavicular (AC) joint, and the sternoclavicular joint. All three joints move and are stabilized through the complex interworkings of the following:
- Bones: The three main bones of the shoulder are the clavicle (also known as the collarbone), the scapula (shoulder blades), and the humerus (upper arm bone).
- Muscles: The muscles of the rotator cuff are the suprasinatus, the infraspinatus, the teres minor, and subscapularis. These muscles hold the head of the humerus in the cavity of the scapula called the glenoid.
In and around the three joints are tendons, ligaments, and cartilage, all designed to stabilize and mobilize the shoulder to perform daily actions both large and small.
Symptoms of rotator cuff injury
A rotator cuff injury occurs when the tendons incur a tear or a strain. This can be an actual separation of the tendons from the muscles, or it can be irritation or inflammation. The injury can range from mild to severe.
The large range of motion and involvement in daily tasks make injury to the rotator cuff very common. It may not be a dramatic movement that causes the injury, but the symptoms are similar regardless of how the injury occurs.
- A dull ache that feels deep within the shoulder
- Difficulty sleeping on the side of the ache
- Decreased range of motion due to pain
- Weakness in the arm
- Radiating pain
All of these symptoms need not be present to receive a diagnosis, but they are the most common signs.
The main cause of rotator cuff injury is overuse or repetitive motion over a period of time. This can include a job with heavy lifting or a regular athletic practice that works the muscles of the shoulders. Professional musicians such as cellists and violinists are also prone to rotator cuff injury in their bowing hands.
Other common causes of rotator cuff injury include suffering an injury to the shoulder, as in a car accident or in full-contact sports, or age-related tendon degeneration.
Due to the location of the injury and the area’s involvement in daily life, it would seem that rotator cuff injury is inevitable. However, there are a few risk factors that make it more likely. These include:
- Age: Rotator cuff injury most commonly occurs in adults over age 40 due to degeneration of the tendons, cartilage, and ligaments.
- Activity level: Professional athletes or those who exercise in highly repetitive sports (e.g., tennis and baseball or softball) have an increased risk of injury to the rotator cuff.
- Tradesmen: House painters and carpenters who work with their arms over their heads on a regular basis are more likely to experience shoulder issues.
Because it is a less severe type of injury, rotator cuff tendinitis is usually treated with a combination of rest and medications. Rotator cuff tears may require more intense treatment, but both conditions generally follow the same basic treatment regimen:
- Rest: Rest is important, as more activity in the joint can cause further injury. Rest is usually indicated for a short period of time, as too much time off can result in thickening of tissue in the shoulder, leading to frozen shoulder.
- Physical therapy: After the initial period of rest, a physical therapist can help to restore safe movement in the shoulder through guided stretching and strengthening. This can also help increase range of motion.
- Medication: Some over-the-counter non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen can help with swelling and pain. Your doctor may offer you a prescription for the initial stage of injury, but often minor tendinitis and tears can be treated safely with low doses of NSAIDS.
- Injections: For pain that is not resolved with NSAIDS, your doctor may recommend steroid injections to reduce pain and swelling. These injections can result in weaker tendons in the shoulder and should not be used frequently.
- Surgery: Surgery for rotator cuff injuries can include arthroscopic tendon repair, open tendon repair, bone spur removal, tendon transfer, and shoulder replacement. Surgery is a much more invasive option and would only be considered when all other options were exercised, or if the location and severity of the injury indicated that surgery was the best choice.
Of all treatment options the best choice is very simple: prevention.
Even in its complexity, the shoulder girdle is designed to move freely and support the work (and play) of our lives. While degeneration of the joint as we age is inevitable, there are ways to help support the shoulder before a rotator cuff injury occurs. Daily strengthening and flexibility exercises for the muscles of the back can help support the work of the ligaments and tendons. Varying your physical routine to include activities that do not stress the shoulder is another way to prevent injury. Finally, taking breaks during repetitive activities and icing your shoulder after long periods of work overhead can help keep inflammation at bay.
Have you ever suffered a rotator cuff injury? What treatment worked for you?
Photo by Pablo Docal via Flickr