Rotator Cuff Injuries. By: Michael LaBella. Objectives:. You will understand the anatomy of the shoulder and rotator cuff. You will be able to identify the types of rotator cuff injuries. You will be able to identify the signs and symptoms of rotator cuff injuries.
By: Michael LaBella
The rotatorcuff is made up of muscles and tendons. It holds the top of the upper arm into the shoulder joint (socket). The rotator cuff is made up of four muscles. The muscles include the supraspinatus, infraspinatus, teres minor, and subscapularis. The tendons attach the muscles to four shoulder bones: the shoulder blade (scapula), the upper arm bone (humerus), and the collarbone (clavicle.) The tendons are broad, measuring approximately 5 centimeters in width, and form a cuff encapsulating the articular surface of the top of the humerus.
Tendinitis:Tendons in your rotator cuff can become inflamed due to overuse or overload, especially in athletes who perform a lot of overhead activities. In some people, the space where the rotator cuff resides can be narrowed due to the shape of different shoulder bones, including the outside end of the collarbone or shoulder blade.
Bursitis: The fluid-filled sac (bursa) between your shoulder joint and rotator cuff tendons can become irritated and inflamed.
Strain or tear:Left untreated, tendinitis can weaken a tendon and lead to chronic tendon degeneration or to a tendon tear. Stress from overuse also can cause a shoulder tendon or muscle to tear.
Normal wear and tear:The rotator cuff tendons can degenerate due to ages (starting around the age of 40) . This can cause a breakdown of fibrous protein (collagen) in the cuff's tendons and muscles.
The physical examiner must detect the torn muscle by isolating the muscles through manual testing. Perform following with patient seated:
of the patient to return the arm to the side slowly indicates a positive test result.A positive result indicates a rotator cuff tear.
the greater tuberosity to jam against the anterior inferior surface of the acromion. Pain reflects a positive test result and indicates an overuse
injury to the supraspinatus muscle and possibly to the biceps tendon
under the coracoacromial ligament and coracoid process.
Diagnosis is usually made after a physical examination, often by a sports medicine physician. X rays are also sometimes used in diagnosis as well as an arthrogram. However, the arthrogram is an invasive procedure and may be painful afterwards. For this reason, magnetic resonance imaging (MRI) is preferred to determine tendon tears as it also shows greater detail than the arthrogram.
Initial Care: Treatment will depend on your symptoms and the length of
time you have them. Your caregiver may want you to limit activity on
your affected shoulder to decrease stress on the tendon. This may help
prevent further damage, decrease pain, and promote tendon heal. The
primary treatment is resting the shoulder and, for minor tears and
inflammation, applying ice packs. You may need to wear a sling to keep
the shoulder from moving.
Medicines: Anti-inflammatory medications may also be prescribed. As
soon as pain decreases, physical therapy is usually started to help regain
normal motion. If pain persists after several weeks, the physician may
inject cortisone into the affected area.
Surgery: If you have a large tear in your rotator cuff, you may need surgery to repair the tear. Sometimes during this kind of surgery, doctors may remove a bone spur or calcium deposits. The surgery may be performed as an open repair through a 6- to 10-centimeter incision, or as an arthroscopic repair with the aid of a small camera inserted through a smaller incision. An arthroscope is used to view the shoulder joint and confirm the presence of a tear. It can also remove any bone spurs that may be present in the shoulder area. The arthroscopic procedures usually involves 2in incision in the outer shoulder. During this time the torn rotator edge may be reattached to the humerus with stitches.
Arthroplasty: Some long-standing shoulder muscle tears may contribute to the development of rotator cuff arthropathy, which can include severe arthritis. In such cases, your doctor may discuss with you more extensive surgical options, including partial shoulder replacement (hemiarthroplasty) or total shoulder replacement (prosthetic arthroplasty). A unique treatment option now available involves the use of a reverse ball-and-socket prosthesis. This reverse shoulder prosthesis is most appropriate for people who have very difficult shoulder problems. These include having arthritis in the joint, along with extensive tears of multiple muscles and tendons (rotator cuff) that support the shoulder, or having extensive rotator cuff tears and a failed previous shoulder joint replacement.
-If drainage continues after 24 hours or you think the drainage is excessive.
-If you have a temperature greater than 101 degrees on more than one reading 48
hours or more after surgery.
-If swelling increases or you develop any persistent numbness in the hand.
-If severe pain remains 48 hours after surgery.
Rehabilitation is crucial to restore the rotator cuff strength. The length of recovery depends of the severity of the tear.
Rehabilitation can be divided into three phases:
Phase I: Pain control: Use of non-steriodal antiflammatory agents, cryotherapy, protection of the injured tissue through the use of a sling or shoulder immobilizer. Exercises such as the pendulum can be performed. This is important for preservation of strength, which will speed recovery time.
Phase II: 5 to 7 days after injury: In an overuse problem, this phase begins when pain diminishes. Range of motion is fully restored. Progressive resistive exercises are initiated to establish normal strength. Some examples of exercises are rotator cuff strengthening and strengthening of the scapular stabilizers. Restoration of strength and mobility of the shoulder is vital to allow for a successful return to sports.
Phase III: Sports Specific Training: To return an athlete to a level of full recovery and maximal performance, the exercises need to be tailored to the specific sport. For example, an interval throwing program is used for the throwing athlete.
Shoulder Pendulum: Let arm move in a circle clockwise, then counterclockwise by rocking body weight in a circular pattern. Repeat 5 times and complete 3 to 4 sessions per day.
Lay on stomach on a table or bed. Put your arm out shoulder level with your elbow bent to 90 degrees and your hand down. Keep your elbow bent and slowly raise your hand. Stop when your hand is level with your shoulder. Lower the hand slowly.
Shoulder Shrugs: scapular stabilizing exercise of retraction and elevation.
Lie on your right side with a rolled-up towel under your right armpit. Stretch your right arm above your head. Keep your left arm at your side with your elbow bent to 90 degrees and the forearm resting against your chest, palm down. Roll your left shoulder out, raising the left forearm until it is level with your shoulder.
Return to play criteria should be individualized. The athlete should experience no pain with rest or activity, full strength in muscles across the affected joint, pain-free shoulder range of motion and negative provocative tests (Neer impingement test, Hawkins impingement test). An athlete who returns to his or her sport too soon tends to alter throwing mechanics and risks injuries not only to the same shoulder, but also to the elbow, hip, and spine. Resumption of activities should be gradual, and the intensity of the activity may need to be modified. Imaging findings alone should not be used to determine return to play.
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