What is the rotator cuff?
We have all heard of it. It is likely that your neighbour, spouse, person doing your renovations, or someone you know at the gym has mentioned the words “rotator cuff” to you before. But what exactly is a rotator cuff and how does it become injured?
Well, essentially the rotator cuff is a group of muscle and tendons that act to stabilize your shoulder during movement by firmly holding the bone in your upper arm (the humerus) into the socket. There are four tendons involved in the rotator cuff: supraspinatus, infraspinatus, subscapularis and teres minor. These muscles are routinely used in our day to day lives and are susceptible to injury.
There are two main categories for rotator cuff injuries:
1 – Traumatic
2 – Repetitive usage
Traumatic injuries are the result of a single event under a heavy load leading to an injury of one or more tendons. An example of this is a motor vehicle accident or a workplace incident. It is advised that the patient seek medical attention as soon as possible in these situations, as there may be a need for surgery.
Rotator cuff injuries caused by repetitive usage result in repeated microtrauma to the tendons over time. Age is also a contributing factor to rotator cuff injuries. As with most tissues in our body, the tendons degenerate and become less strong as we age, making them more susceptible to repetitive use injuries.
Other disease processes in our bodies may also contribute to rotator cuff irritation such as different types of inflammatory arthritis and metabolic diseases like diabetes or lupus.
What are the symptoms of a rotator cuff tear?
The most common symptoms of a rotator cuff injury is pain with activity, however, patients may also experience pain at rest. There may be a loss of range of motion which makes reaching over head difficult and painful. Other common symptoms include: pain in the shoulder while lying on either side at night and the sensation of weakness in the arm.
How do you diagnose a rotator cuff injury?
For the diagnosis of a rotator cuff tear, a physician will take a detailed history to start. This is typically followed by physical examination of the shoulder itself. The physician will move your arm into different positions to see which tendons are painful, how much strength you have and if there has been any lost range of motion.
Imaging the shoulder is also useful in quantifying the severity of the tear or injury. A shoulder ultrasound is helpful to visualize the physical properties of the tendons themselves. It is also useful to see if there is anything else going on that could potentially cause pain and dysfunction such as calcification or bursitis. Other imaging modalities may include an X-Ray, CT or MRI.
What is the treatment?
Treatment of a rotator cuff tear varies between individuals, depends on the significance of the injury, the patient’s needs and if any other treatments have already been done.
There are many different forms of treatment. The main categories include:
1 – Conservative management
2 – Injections
3 – Surgery
This includes rest, ice, heat, but most importantly exercises from a physiotherapist. The tendons of the rotator cuff are small but mighty in their function and they require very specific exercises to strengthen them for optimum performance.
There are multiple different types of injections that can be done for a rotator cuff injury. Corticosteroids are useful for downregulating pain and facilitating the person’s ability to perform the physiotherapy strengthening exercises. Dextrose may also be useful to downregulate pain.
Other injections that may help with regeneration of the tendons and tissues include: platelet rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and lipoaspirate tissue transfer.
In some instances, surgery may be the best option in repairing the tendons to stabilize the shoulder. It is often indicated in acute traumatic injuries, but it all depends on the degree of injury.