Rotator Cuff Injury

Acute injuries occur suddenly due to a specific event or trauma. Common causes include:

• Lifting Heavy Objects: Attempting to lift heavy objects, especially with improper technique, can strain or tear the rotator cuff tendons.
• Falls: Falling onto an outstretched arm or directly on the shoulder can result in a sudden tear or strain.
• Sudden Movements: Quick, forceful movements, such as those experienced during sports activities or accidents, can lead to acute injuries. This includes throwing a ball, swinging a racket, or lifting heavy weights.

Degenerative injuries develop over time due to gradual wear and tear on the tendons. Factors contributing to degenerative injuries include:

• Repetitive Stress: Repetitive overhead activities, such as those involved in certain sports like baseball, tennis, and swimming or occupations like painting or carpentry, can wear down the rotator cuff over time.
• Ageing: As people age, the tendons of the rotator cuff naturally degenerate and become more susceptible to injury. The blood supply to the tendons decreases with age, which impairs the body’s ability to repair minor injuries.
• Bone Spurs: Bone spurs, which are bony growths that can form on the edges of bones, particularly in the shoulder, can rub against the rotator cuff tendons and cause damage over time.
• Poor Posture: Chronic poor posture, such as rounded shoulders or forward head posture, can place additional stress on the rotator cuff tendons, leading to injury.

The shoulder specialist starts by obtaining a thorough medical history before diagnosing. This includes asking about the patient’s symptoms, when they first appeared, and any activities that might have caused or worsened the pain. The shoulder specialist will also ask about past shoulder injuries or conditions that could be relevant to the current issue.

During the physical examination, the shoulder specialist will assess the shoulder’s range of motion by asking the patient to move the arm in various directions. Resistance workouts will be used to test the shoulder and arm muscles’ strength and find any weak spots. The shoulder specialist will also feel for tenderness in certain parts of the shoulder to figure out exactly where the pain is.

Imaging tests are used to provide a clearer view of the structures inside the shoulder. Common imaging tests include:

• X-rays: While X-rays do not show tendons, they can reveal bone spurs or other bone issues that might be causing symptoms.
• Ultrasound: This test uses sound waves to create images of the soft tissues in the shoulder, helping to identify tears or inflammation.
• Magnetic Resonance Imaging (MRI): MRI scans provide detailed images of both bones and soft tissues, making it easier to see the extent of tendon damage or tears.

Non-surgical treatments are often effective for mild to moderate rotator cuff injuries and are typically the first line of treatment. Among these treatments are:

• Physical Therapy: Patients follow a tailored exercise program to improve shoulder flexibility, strength, and range of motion. Manual therapy techniques, such as massage or joint mobilisation, may also be used to relieve pain and improve function.
• Medications: Various medications can help manage the symptoms of rotator cuff injuries. Over-the-counter pain relievers like ibuprofen or acetaminophen can reduce pain and inflammation.
• Ice and Heat Therapy: Applying ice packs to the shoulder can help reduce inflammation and numb the pain, while using heat packs can relax and loosen tissues and stimulate blood flow to the area.
• Steroid Injections: Corticosteroid injections may be recommended to reduce inflammation and pain. These injections are typically administered directly into the shoulder joint or the surrounding area, and they work by reducing inflammation, which in turn alleviates pain and swelling.

Surgical treatment may be needed if non-surgical treatments are ineffective or if the rotator cuff injury is severe.

• Arthroscopic Rotator Cuff Repair: Arthroscopic surgery is a minimally invasive procedure that involves making small incisions and using a tiny camera (arthroscope) to guide the surgery. This procedure typically has a shorter recovery time. Torn tendons are reattached to the bone during arthroscopic surgery using sutures or anchors.
• Open Surgery: Open surgery is sometimes required for large or complex tears. This traditional method involves a larger incision to repair the damaged tendons. In cases where the rotator cuff tendons are too damaged to be repaired, a tendon transfer may be performed. This involves using a nearby tendon to replace the damaged one.
• Shoulder Replacement Surgery: Shoulder replacement surgery may be considered in severe rotator cuff damage cases. This procedure involves replacing the damaged parts of the shoulder with artificial components.