Rotator cuff tear
Have you ever though about how the arm is connected to the shoulder? Your shoulder is a ball-and-socket joint: the head of your upper arm bone is like a ball, it fits into a shallow socket in your shoulder blade. This structure allows the arm to move around. However, how to keep the arm there from dropping out? That’s what your rotator cuff does.
The rotator cuff is a group of four muscles that come together as tendons to keep your arm in your shoulder socket. The rotator cuff attaches the humerus to the shoulder blade and helps to lift and rotate your arm.
When one or more of the rotator cuff tendons is torn, the tendon no longer fully attaches to the head of the humerus. Then you would feel limited when moving your arm.
There is a lubricating sac called a bursa between the rotator cuff and the bone on top of your shoulder (acromion). The bursa allows the rotator cuff tendons to glide freely when you move your arm. When the rotator cuff tendons are injured or damaged, this bursa can also become inflamed and painful.
The pain associated with a rotator cuff injury may:
- be a dull ache deep in the shoulder
- pain at night, sleep-disturbing, particularly if lying on the affected shoulder
- make it difficult to comb your hair or reach behind your back
- weakness when lifting or rotating your arm
- crepitus or crackling sensation when moving your shoulder in certain positions
Tears that happen suddenly, such as from a fall, usually cause intense pain and immediately weakness.
It should be noted that some rotator cuff tears are not painful. These tears, however, may still result in arm weakness and other symptoms.
Acute rotator cuff tear
An acute rotator cuff tear occurs when there is excessive force exerted on the rotator cuff tendon. The amount of force needed to tear a rotator cuff tendon varies from person to person and the condition of their rotator cuff tendon prior to trauma. In a person with a healthy tendon, it could require the stress of a fall, landing on an outstretched arm to tear the tendon. But if the tendon has pre-existing degeneration, the force require for it to tear may be modest, such as lifting a moderately heavy object.
Chronic rotator cuff tears are commonly seen in people whose occupations or sports require them to reach their arms overhead frequently, such as in baseball pitchers, tennis players, or even painters. Use of the arm in such a position causes repetitive trauma to the rotator cuff muscles and tendons.
In chronic rotator cuff tears, at first the pain can be mild and controllable with aspirin or ibuprofen, over time, the pain may become more noticeable at rest, and no longer goes away with medications.
During the physical exam, your doctor will press on different parts of your shoulder and move your arm into different positions. He or she will also test the strength of the muscles around your shoulder and in your arms.
An X-ray can visualize bone spurs or other potential causes for your pain, the rotator cuff tear can’t show on X-ray image though.
The ultrasound can produce images of the affted shoulder, particularly soft tissues(muscles and tendons), it can produce images when you’re moving your arm for better diagnosis.
Magnetic resonance imaging (MRI)
The MRI images obtained display all structures of the shoulder in great detail.
If you have symptoms of rotator cuff tear, you may plan to make an appointment with an Orthopedist right away. Leaving untreated, keep using the arm, the tear can get larger over time. Early treatment will also get you back to your normal routine that much quicker.
The goal of any treatment is to reduce pain and restore function.
- Rest. Your doctor may suggest rest and limiting overhead activities. He or she may also prescribe a sling to help protect your shoulder and keep it still.
- Activity modification. Avoid activities that cause shoulder pain.
- Nonsteroidal anti-inflammatory medication. Drugs like ibuprofen and naproxen reduce pain and swelling.
- Strengthening exercises and physical therapy. Specific exercises will restore movement and strengthen your shoulder. Your exercise program will include stretches to improve flexibility and range of motion. Strengthening the muscles that support your shoulder can relieve pain and prevent further injury.
- Steroid injection. If rest, medications, and physical therapy do not relieve your pain, an injection of a local anesthetic and a cortisone preparation may be helpful. Cortisone is a very effective anti-inflammatory medicine; however, it is not effective for all patients.
Your doctor may recommend surgery if your pain does not improve with nonsurgical methods.
- Arthroscopic tendon repair – re-attaching the tendon to the head of humerus (upper arm bone).
- Open tendon repair – re-attaching the damaged tendon to the bone in another way.
- Tendon transfer – using a nearby tendon as a replacement to the damaged tendon when it’s too damaged to repair.
- Shoulder replacement – massive rotator cuff injuries may require replacement wth an artificial joint’s stability.
A minor rotator cuff injury often heals on its own, with proper care.
- Rest your shoulder
- Apply ice and heat – use a cold pack for 15 to 20 minutes every three or four hours to reduce the inflammation, in 3 days when the inflammation goes down use hot packs or a heating pad to relax tightened and sore muscles.
- Drink pineapple juice – pineapples contain an enzyme known as bromelain which can ease swelling and pain in soft tissue injuries.
- Consume turmeric – add turmeric to your cooking or brew yourself a cup of turmeric tea to relieve the inflammation.
Even if you fully recover, it’s good for you to take some prevental measures in your work or workout.
1. Do warm-up
2. Do stretching exercises, especially stretch the muscles at the back of your shoulder
3. Get a shoulder brace support, it can support your shoulder and immobilize it in place, protect it from injuries, improve blood flow, alleviate the shoulder pain and muscle tightness. Make sure you get one lightweighted, ultra-thin and breathable, so you can feel good even wearing for a whole day. A breathable one can reduce the risk of skin rashes from long-time wearing.