More on the #@%*$; rotator cuff: Part II

The human shoulder joint

Image via Wikipedia

The pesky rotator cuff (RTC) is the group of muscles and tendons that attach the arm to the shoulder joint and allow the arm to move in all directions. 

Four main muscle-tendon groups  make up the RTC.  

The supraspinatus runs across the top of shoulder and is the most used, abused and most commonly injured of the four muscles. The supraspinatus makes it possible to abduct or raise one’s arm.

Next are the infraspinatus and teres minor muscles. These make it possible for the arm to externally rotate, or move out away from the body.

The last muscle is the subscapularis, which controls internal rotation – turning the arm toward the body.

How does the pesky rotator cuff become injured? The most common cause is trauma as in sports injuries (think throwing a ball, swinging a club or bat,  being thrown forcefully to the ground) and falls. I’ve seen many RTC tears occur after a fall onto an outstreched hand (FOOSH), which is especially common in an icy slip and fall. Yup – this protective mechanism that we all instinctively use when we fall, to keep ourselves from hitting our face or head, is bad news for the rotator cuff, as the force of the fall is transmitted up the arm into the rotator cuff. 

Another way the rotator cuff is injured is through overuse and cumulative trauma. This is often seen in industrial workers, commercial drivers, orchestra conductors and the like: those  who perform the same arm motions day after day, year after year. Over time, this leads to RTC tendonitis, which may progress to becoming chronic, causing the RTC tendon to become calcified and brittle. A calcified tendon is more prone to tearing when an injury does occur, and also can develop microtears and erosions that can go on to become major tears over time.

A third cause of RTC tears is arthritis, such as spurs and other bony deformity and misalignment in the shoulder from previous trauma. Bony spurs or a misaligned joint can impinge upon, or wear away the RTC over time, eventually causing rupture. This is why it’s not surprising to see the stereotypical “little old lady” who despite having never been athletic ends up with an RTC tear.

How would you know if your rotator cuff is injured? Suspect a tear or strain any time there has been a fall or acute injury that is painful and limits your ability to move your arm, or any time recurrent shoulder pain becomes worse after overuse. Symptoms of RTC tear, tendonitis and strain are quite similar – inability to raise the arm from the side to shoulder level, weakness, pain that radiates down the arm into the upper arm muscle (deltoid) or under the arm, and inability to sleep on the affected side, so it’s important to seek health care to diagnose the problem. A thorough exam, plus a combination of diagnostic imaging such as MRI, CT and/or x-ray can determine the problem.

If a rotator cuff tear occurs, often surgery is needed to repair the tear. This will depend upon the health and age of the person and the size of the tear. Tears do not “heal up” on their own, but sometimes a small tear is not repaired. Instead, rehab (physical therapy) can improve the arm by strengthening the surrounding muscles, but does not “heal” the tear. In either case, it’s important to seek care promptly; delayed treatment can lead to atrophy (weakening) of the muscles and tendon, making a later repair difficult or impossible.

We use our arms every single day. A rotator cuff injury can keep you from doing the simplest things – from getting dressed to driving a car. Take care of your shoulder so you can keep doing the things you need and love to do – whether it’s climbing a wall, playing sports, or hugging the ones you love. 

Disclaimer: The information provided here is not intended to replace treatment and advice by one’s own health care provider.

References: American Academy of Family Physicians

© Huffygirl 2011

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