The rotator cuff consists of 4 muscles (Fig. 1) that come from the shoulder blade to cross over the humerus (upper arm bone) via their tendons (rope-like structures that attach muscles to bone).
These muscles help stabilize and align the shoulder joint during movement. If either of the muscles or its tendon is stressed or strained beyond its capacity, it may cause injury.
Types of rotator cuff injuries may vary from acute injury, to cumulative degeneration (micro tears within the tendon), to a partial or full tear.
Common symptoms of rotator cuff injury include:
- Variable pain with certain shoulder movements / activities / angles
- Inability to lie / sleep on the affected shoulder
- Crepitus or cracking sensations with certain shoulder movements / angles
- Sleep disrupted due to inflammatory pain
- Weakness in the arm (severe injury)
Common Types of Rotator Cuff Injuries
- Wear and tear
Normal age-related muscle and tendon deterioration, and repetitive motion over the years cause degenerative microtrauma to the muscles and tendon
The tendon or bursa (a lubricating cushion sac) underneath the end of collar bone is “pinched” during movements of lifting the shoulder or arm. This can cause pain when the arm is raised between shoulder height and overhead.
Repeated impingement can irritate the tendon and bursa which can lead to swelling and tendinopathy, and even tearing (minor or major) of the tendon, if symptoms are persistent.
Tendinopathy occurs with repeated overload of the tendon, and is characterised by constant inflammation at the site of the tendon. As the condition progress, it may lead to a tear.
- Rotator cuff tear
The tendon can tear partially or completely. This can result from tendinopathy or trauma. Surgery may be required, depending on the patient.
These injuries can sometime overlap and co-exist or be presented independently.
- Traumatic injury (e.g. fall, contact sports)
- Repetitive overhead motions or over in sport (e.g. tennis-playing, swimming) or at work / hobbies (e.g. painting, carpentry, butchery, construction and electrical work)
- Activities involving heavy lifting and pulling (e.g. gardening, hanging clothes out, carrying heavy grocery bag)
If left unattended, the injury may cause the shoulder to progressively weaken. With persistent pain and avoidance of movement, there is a risk of frozen shoulder developing.
- Avoid / reduce / modify painful activities
- Sling to rest and immobilise the shoulder (occasionally warranted by the doctor for short-term comfort)
- Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain control and inflammation
- Corticosteroids injection
- Physiotherapy for active pain relief and recovery, strengthening and return to daily activities
Physiotherapy and Rehabilitation
- Pain reduction and inflammation control using modalities and massage
- Improve postural, rotator cuff and scapular (shoulder blade) muscle strength and mobility and restore shoulder function with rehabilitative exercises
If the shoulder does not respond to conservative approaches or the tear is extensive and disabling quality of life, surgery such as key-hole repair (arthroscopy) may be suggested / required.