What is the Rotator Cuff?
The rotator cuff is a group of four muscles whose role is to control the joint during shoulder range of motion. The four muscles of the rotator cuff are the supraspinatus, infraspinatus, subscapularis, and teres minor. These muscles work together to produce different motions of the arm. Due to the complex actions of these muscles, they are susceptible to overuse injuries.
How common are injuries to the rotator cuff?
Rotator cuff injuries are a common yet complex condition with approximately 66.7% of adults having shoulder pain in their lifetime. Rotator cuff injuries can generally be split into three subcategories: rotator cuff tendonitis (overuse); acute traumatic tears; and degenerative tears. An acute traumatic tear is exactly as it sounds. It is the direct result of a traumatic event like lifting something heavy and immediately feeling pain. Lastly, a degenerative tear is one that occurs slowly over time but not from any specific event. The separation of traumatic and degenerative tears is very important because the treatment of each can be significantly different.
Can I prevent rotator cuff injuries?
While absolute prevention is impossible to achieve, there are ways to significantly reduce the risk of suffering a rotator cuff tear. Engaging in regular resistance training that targets both the rotator cuff muscles and the supporting muscles around the shoulder blade will help reduce the risk of sustaining a rotator cuff injury. Weekly participation in resistance training is strongly advised for all age groups and becomes significantly more important as we age, in order to not only reduce the risk of shoulder injuries but to maintain lean muscle mass throughout the entire body.
How can I tell if I have a rotator cuff injury?
Magnetic Resonance Imaging (MRI) is considered the gold standard for diagnosing a rotator cuff tear however, not all patients with shoulder pain need an MRI. Should you find yourself with a painful shoulder but cannot think of a specific event that caused the pain, you may have the mildest form of a rotator cuff injury, which is called rotator cuff tendonitis. Getting rest and avoiding painful movements should resolve the pain within a few days. However, if the pain persists or increases in intensity, the best course of action is to seek medical advice from an orthopedic sports medicine practitioner. If the pain occurs immediately following a specific event and results in significant pain and the loss of functional use of the shoulder, a definitive diagnosis is needed.
Formal Diagnosis and Treatment
As previously mentioned, not all rotator cuff tears are treated the same. Acute traumatic rotator cuff tears, especially in those between 50-65 years of age, are often treated more aggressively through surgical repair of the torn tendon(s). In patients where the tear is the result of gradual degeneration, the first treatment is usually formal physical therapy. The goal of physical therapy is to first address the pain followed by gradual and progressive strengthening of the rotator cuff muscles and supporting muscles of the shoulder blade. Should physical therapy not significantly improve the pain and dysfunction in the first 6 weeks of treatment, a steroid injection may be offered by the treating physician. Lastly, with continual failure to progress, arthroscopic surgical intervention is considered.
Post-Operative Considerations
If surgery becomes the treatment of choice, there are important factors to know and consider after surgery. Surgical repair of the rotator cuff is a very common procedure with very predictable improvements in pain and function. The post-operative pain can be significant for some patients but is often effectively managed with pain medications and ice. The single most important rule following surgical repair is to allow the tendon to sufficiently heal by following the post-operative protocol provided by the surgeon.
Rotator cuff tears are a common orthopedic condition and understanding the importance of performing resistance exercises regularly and maintaining proper body mechanics during physical labor will reduce the risk for rotator cuff injuries. Consult the orthopedic experts at OSMI if you are experiencing pain in your shoulder and would like an evaluation.
Our goal at the Orthopedic and Sports Medicine Institute (OSMI) is to provide our patients quality, cutting-edge orthopedic treatments, both surgical and non-surgical. If you have questions about rotator cuff injuries, shoulder joint pain, or physical therapy, please submit an online appointment request or contact our office at 817-529-1900.
