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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The #@%*$; rotator cuff

The human shoulder joint

The amazing shoulder (Image courtesy of Wikipedia)

What is the rotator cuff anyway? We hear a lot about it these days, from injured quarterbacks  in the news, to your neighbor down the street who tore his falling on the ice. Prior to MRI being widely available, we heard very little about tears of this offending musculo-tendonous group, because there was no good way to image it, and no easy surgery to fix it. Most people did not even know they had a rotator cuff, and many still don’t, if the names I hear it called are any indication. People describe it to me as anything  from the “rotator cup” to “rotary cup”, to just plain “rotatory cut.”

So what is the rotator cuff? It’s the group of muscles and tendons that surround the shoulder joint, and make it possible for the shoulder to move in all the amazing directions that it does, otherwise known as flexion, extension, abduction, adduction, internal rotation and external rotation. Basically north, south, east, west and everything in between. When our rotator cuff is working properly, we don’t notice it at all. But should it become strained, pinched or torn, we’re acutely aware due to pain and/or loss of movement.  I recently strained my rotator cuff (it was a combination of Yoga class and weight lifting) and spent a miserable week or so nursing it back to health. I tried all the traditional and nontraditional methods I knew to put it right, because when you can’t lift your arm, can’t sleep and can’t get dressed without help, you’re ready to try just about anything. I did manage to get it better and have sworn off Yoga class for now, but am back to biking, weight lifting and climbing, but trying to be a little more reasonable about it.

In the next  few days I’ll explore the pesky rotator cuff a little more, hopefully to help us all understand it better, and know what to do if it’s injured.

Addendum: I just found out my problem is calcific tendonitis of the rotator cuff. So, I’m going to stop treating it myself and get some expert consultation, hopefully nipping it in the bud before any more chronic problems develop.  (Don’t want anything to keep me from climbing or biking now do I?)

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