The rotator cuff provides the rounded appearance to the shoulders and allows a free movement at the shoulder joint. Two bones come together at the shoulder joint: the upper arm abone called humerus, and the shoulder blade called the scapula. Four major muscles called the subscapularis, supraspinatus, infraspinatus and teres minor connect the two bones to coordinate various movements in the joint. At the origins or insertions into the bones, the muscles are flattened to form the tendons which connect the muscles to the bones. Together the bones and muscles for the rotator cuff of the shoulder joint. At the points of friction and between the rotator cuff and the joint, there are cushions of small fluid filled sacs called bursae.
More About Shoulder Pain
Pain in the shoulder can be due to problem in the muscles, bones, bursae, or the joint. Any injury or inflammation of these structures in the rotator cuff can cause pain in the shoulder. Inflammation in the tendons called tendinitis, and that in the bursae called bursitis cause pain in the shoulder. The tendons may be strained or torn partially or completely due to injury and cause pain the shoulder along with limitation of movements at the joint.
Anybody can have injury in the rotator cuff. This is common in athletes like baseball pitchers, swimmers who do freestyle, butterfly or back stroke and tennis players or others who serve the ball using a racket as they have the rotator cuff subjected to repeated stress during overhead movements of the arm. This also occurs due to occupational stress as in painters and carpenters. Lifting or pulling an object suddenly and improperly can injure the rotator cuff. Falling on the arm or using arm as a support to prevent a fall can also strain or rupture the tendons or muscles. Poor posture or slouching forwards of neck and shoulders to throw something can limit the space for the muscles to act and hence results in strain and tears. The rotator cuff may be affected by the usual degeneration of aging process. The fibers of the tendons and muscles are weakened and are hence more prone to injury. Calcium deposits may develop in the cuff which can cause irritation.
Symptoms
Shoulder pain is the commonest sign of a damaged cuff. Pain occurs when lifting the arm overhead, trying to reach behind the back, throwing something forcefully, and pulling. Activities like combing of hair, wearing a jacket, and reaching out for containers on the shelf in the kitchen may be painful. Pain is typically more in the range of 60 to 120 degrees of motion of the arm. This is called the painful arc of motion. It is aggravated by sleeping on the affected side. The shoulder feels weak and there is limitation of range of movements in the shoulder. Since the shoulder hurts, there may be voluntary immobilization.
A consultation with the doctor is important if shoulder pain is severe or lasts more than a week. Immobility and weakness of the shoulder are other reasons to see a doctor.
Treatment
Minor injuries of the rotator cuff will heal spontaneously. Medicines like aspirin, ibuprofen, naproxen, or acetaminophen may be taken for pain relief. Exercise therapy is the first approach in treatment. This helps to regain muscle strength and increase flexibility over few or several weeks depending upon the severity of the injury. In severe injuries, medicines called steroids will need to be injected into the joint to relieve pain and inflammation. A large tear may need surgical repair and chronic non-healing tears and very severe injuries that may damage the bones may need a partial or total shoulder joint replacement called arthroplasty.
In addition to pain killers some simple measures help to reduce pain. The injured shoulder may be supported in a sling and rest and ice packs may be advised for pain relief. Exercises are then introduced gradually by a physiotherapist.
Surgery is needed if exercise and medical therapy fails to relieve pain and restore motion in the arm. Early surgery however can be done if there is a tear that is large in size, caused by sudden severe injury, and causes profound weakness in the arm. In the surgical procedure, the torn tendon is repaired. Different approaches may be used for repair, like the open, mini, or all-arthroscopic repair. The choice and outcome of a chosen technique is also governed by the expertise of the surgeon.
Exercises
Exercises are the cornerstone of therapy in rotator cuff injury to regain the lost strength and movements. Some of the exercises are as under:
- Lying on the stomach, the arms are raised one at a time such that the elbow is bent at 90 degrees with hand down. The hand is raised until it comes to the level of the shoulder.
- Lying on one side, a towel is rolled up to place a support under the armpit and the hand raised above the head. The other hand is kept by the side with elbow bent at 90 degrees to keep the forearm against the chest and palm down. The shoulder of the higher arm is then rolled out until the forearm is raised to the level of the shoulder and then lowered.
- After this is done with both arms, the entire set is repeated with rolling the higher shoulder in and then raising the forearm.
- In standing position, one arm at a time is raised halfway between the front and side of the body with thumb down. The arm may be lifted until level or till pain is felt.
All exercises may be repeated till the arms are tired.
The best way to ensure proper healing without compromise of motility is to avoid inactivity and over-activity. Exercises should be done in a pain-free range of motion. Prolonged total rest can cause shoulder stiffness. Weights for strength training and stretches should be done in balance as advised by the physiotherapist. Exercises should be continued even after the range of motion has been gained.
Prevention
Regular shoulder exercises can help to prevent recurrence of pain. The exercise regimen advised by the physiotherapist or healthcare provider should be done as these help to train and strengthen various muscles around the shoulder, front, and back of chest. If risk of rotator cuff injury is due to occupation or hobby, then there should be frequent breaks when the shoulder is used repetitively in positions likely to affect he cuff. Slight pain can be relieved by hot or cold fomentation and proper exercises. Rotator cuff injuries can be painful and may restrict activity. Exercise holds promise to restore mobility and provide pain relief. Exercise regimen should be followed religiously.
