Rotator Cuff Injuries We often hear how baseball pitchers are lost for the season due to injuries to the rotator cuff that often requires surgery. This shoulder problem is very prevalent among the general population as well, especially among the elderly. By understanding the mechanisms and factors that contribute to rotator cuff injury, this shoulder problem can often be avoided. The Rotator Cuff The rotator cuff is made up of mainly four muscles that help support and move the shoulder joint. These four muscles are supraspinatus, infraspinatus, teres minor and subscapularis muscles. The muscles form tendons surrounding the shoulder joint, and are responsible for moving our shoulder front, up and back during regular daily activities. Lying over the tendons is a fluid-filled sac (shoulder bursa) that helps lubricate and cushion the shoulder. How Injuries Occur The rotator cuff can be injured in a variety of ways: Fall on the shoulder when the arm is outstretched; Excessive overuse of the shoulder; High velocity trauma to the shoulder (i.e. car accident); Heavy lifting or lifting in an awkward position; Degenerative conditions due to wear-and-tear among the elderly; Poor posture. The Impingement Syndrome When the bursa and rotator cuff muscles become inflamed, an impingement syndrome can develop. A bone spur can chronically irritate the tendons resulting in "impingement" of the muscles. Patients afflicted with this problem often complain of pain when throwing or placing items above on shelves. There can be shoulder weakness and limited movement. The patient will often complain about difficulty with common activities, such as putting on clothes or combing their hair. Rotator Cuff Tears Even more serious are rotator cuff tears. These can occur due to chronic inflammation or injury to rotator cuff muscles, which often lead to severe weakness and continuous shoulder pain. Diagnosis of Rotator Cuff Injuries Your physician will conduct a physical exam of the shoulder, checking the strength and range of motion of the extremity. X-rays may need to be taken to determine if there are any fractures or bone spurs present. Further tests may include a magnetic resonance imaging (MRI) of the shoulder, which can detect soft tissue damage. An arthrogram is a special type of x-ray in which dyes are injected to better outline the tissue structures of the shoulder. An arthroscopy is an invasive surgical procedure, which allows direct visualization of the rotator cuff tendons and surrounding tissues. Treatment of Rotator Cuff Injuries Treatment is dependent on the severity of the injury. If it is determined to be a minor tear or sprain, simple home rehabilitative exercises can be prescribed. Daily ice packs to the shoulder will help with inflammation, as well as taking anti-inflammatory medications such as ibuprofen and topical liniments, containing capsicum, with ice-massage. Avoiding repetitive activities with your shoulder is also recommended. If an inflamed bursa alone is the problem, a carefully placed corticosteroid injection may be helpful, but the number should be limited, since they may be related to cartilage injury. If the rotator cuff injury is deemed to be more severe (such as a complete tear), surgery may be the only option. In addition to visualization, arthroscopy can be used to perform surgery, helping sew large tears back together and shaving prominent bone spurs. Weeks of physical therapy are then recommended to strengthen the shoulder back to its normal form. Prevention is Key The most important aspect in avoiding rotator cuff tears is stopping whatever activity you are doing whenever it causes pain. Try to limit moving heavy objects or repetitive shoulder motions , without warming up first, and rest the shoulder whenever possible. Learning proper shoulder exercises and posture is also helpful. If the pain in your shoulder appears to be getting worse or there is sudden weakness, it is important to consult with your physician for early diagnosis. Richard T Herrick,MD herrickclinic@mindspring.com www.herrickclinic.com