The shoulder is a ball and socket joint where your upper arm bones (humerus), shoulder blades (scapula), and collarbone (clavicle) meet. Each shoulder is held in place by a group of soft tissues called the rotator cuff. The rotator cuff consists of muscles and tendons that cover and protect the upper arm bones. This allows you to have a range of motion with your arms.
Each year, nearly two million people in the United States visit their doctors because of rotator cuff problems. Below we discuss what a rotator cuff injury is, it’s symptoms, treatments, and how to prevent future injuries.
What is a Rotator Cuff Injury?
When one or more of the rotator cuff tendons are torn they begin to separate from the upper arm bone (humerus). This can be a partial tear or full detachment from the humerus.
A partial tear is known as an incomplete tear because the tendon is still slightly attached to the humerus. A complete or full-thickness tear has separated from the bone. It is common to see holes or rips in the tendon.
Symptoms of a Rotator Cuff Injury
The following are the most common symptoms associated with a rotator cuff injury:
- Pain at Rest, Especially at Night
- Pain with Lifting the Arm
- Weakness with Moving the Arm
- Popping or Clicking Sounds with Arm Movement
If the rotator cuff is torn in an accident it can cause immediate and intense shoulder pain with arm weakness. Every patient may not experience consistent, long-term pain but typically they will experience arm and shoulder weakness.
How the Rotator Cuff Injury is Diagnosed
Rotator cuff tears are a common pain and disability among adults. If you are experiencing shoulder pain and/or weakness it is imperative to have a physical exam. If you have a rotator cuff tear and continue to use the shoulder, you can cause further damage.
During the physical exam, the medical professional will check the shoulder and shoulder joint for tenderness, inflammation, and range of motion. Post examination, if they believe you have a torn rotator cuff they will order tests to confirm the torn tendon. Listed below are the most common exams:
X-rays use invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs.
You will remove any clothing or jewelry that may interfere with the imaging. A technician will position you on the x-ray table beneath the x-ray plate. They may cover the parts of your body that are not being imaged with a lead apron known as a shield. The apron shields you from unwanted radiation being introduced to the body.
They will ask that you remain as still as possible to avoid capturing a blurry image. Once they have you in position, they will move behind a protective window and images will be taken. The technician may shift your position to get additional views of the injured site.
Ultrasound diagnostics is also called sonography. It is an imaging method that uses sound waves to produce images of internal structures. This is particularly effective for rotator cuff injuries. The ultrasound probe can be angled in different ways thus allowing doctors to evaluate each tendon at various angles. Ultrasounds are a great alternative diagnostic exam for people who can not undergo an MRI.
Magnetic Resonance Imaging (MRI)
The next scan that a doctor may request is known as magnetic resonance imaging or MRI. The MRI machine looks like a large, round tube with the inside hollowed out.
They will ask you to remove anything that contains metals such as jewelry, glasses, or hearing aids. Typically, you will change into a gown before lying on a movable table that slides into the opening of the tunnel.
MRI machines create a strong magnetic field around you while directing radio waves at your body. You do not feel the magnetic field or the radio waves. During the scan, the internal part of the magnet will produce loud, repetitive tapping and thumping noises. The technician may give you earplugs to block out the noise.
These scans typically last anywhere from fifteen minutes to one hour and you must remain still unless directed otherwise. If movement occurs then the images will not be clear thus resulting in a repeat MRI.
Treatments for a Rotator Cuff Injury
Nonsurgical treatments have been known to relieve pain and improve the range of motion in nearly 85% of patients. If the pain does not improve with nonsurgical treatments then your doctor may recommend surgery.
Surgery is recommended for large tears and if symptoms that have lasted longer than six to twelve months. Below are the most common nonsurgical treatments used for rotator cuff injuries.
Resting the Injured Shoulder
The first form of treatment is to simply rest the shoulder. If you usually use the injured shoulder for the majority of activities you will need to use the opposite shoulder. This will allow the injured shoulder to rest.
Modification of Activities
Modifying your activity is crucial to the healing process. If you complete repetitive movements overhead then those activities will need to be modified. You will also need to restrict any activity that causes shoulder pain.
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
NSAIDs are anti-inflammatory drugs such as ibuprofen, aspirin, and naproxen. These drugs reduce pain and swelling. NSAIDs should be used in conjunction with rest and activity mitigation.
A physical therapist can work with you on exercises to restore your range of motion while simultaneously strengthening the shoulder. Strengthening shoulder muscles can relieve pain and prevent further injury.
After trying the above treatments, your doctor may recommend a steroid injection. This is a local anesthetic combined with cortisone that has been known to reduce inflammation. Sadly, it is not effective for all patients.
If you receive the injection, there is no way to know how long the effects will last. It can be effective for weeks, months, or even years. Typically injections are known to provide relief for approximately three months.
Pain Management with Arizona Pain and Spine Institute
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