Over the last several months, we’ve been discussing the various problems that can cause shoulder pain. Previous articles have focused on dislocation, separation, and rotator cuff disease. This month’s article is information you should know about a torn rotator cuff. The shoulder is the most moveable joint in the body, making it also the most unstable joint — which is why it is the site of so many different problems. The shoulder joint depends on the surrounding ligaments, tendons, and muscles to hold the ball in place. The rotator cuff is a group of four tendons that work together to stabilize the shoulder joint. Each tendon is attached to a muscle that moves the shoulder in a specific direction.
Rotator cuff tendons often become inflamed from overuse, aging, or a fall on an outstretched hand or another traumatic cause. Sports or occupations requiring repetitive overhead motion or heavy lifting can also place a significant strain on rotator cuff muscles and tendons. Over time, as a function of aging, tendons become weaker and degenerate. Eventually, this degeneration can lead to complete tears of both muscles and tendons. These tears are surprisingly common. In fact, a tear of the rotator cuff is not necessarily an abnormal situation in older individuals if there is no significant pain or disability. Fortunately, these tears do not lead to any pain or disability in most people. However, some individuals can develop very significant pain as a result of these tears and they may require treatment.
Symptoms. Typically, a person with a rotator cuff injury feels pain over the deltoid muscle at the top and outer side of the shoulder, especially when the arm is raised or extended out from the side of the body. Motions like those involved in getting dressed can be painful. The shoulder may feel weak, especially when trying to lift the arm into a horizontal position. A person may also feel or hear a click or pop when the shoulder is moved. Pain or weakness on outward or inward rotation of the arm may indicate a tear in a rotator cuff tendon. The patient also feels pain when lowering the arm to the side after the shoulder is moved backward and the arm is raised.
Diagnosis. Your doctor may detect weakness but may not be able to determine from a physical examination where the tear is located. X-rays, if taken, may appear normal. An MRI or ultrasound can help detect a full tendon tear or a partial tendon tear.
Treatment. Treatment for a torn rotator cuff depends on the severity of the injury, the age and health status of the patient, and the length of time a given patient may have had the condition. The usual recommendation with a rotator cuff injury is to rest the shoulder, apply heat or cold to the sore area, and take anti-inflammatory medicine to relieve pain and inflammation. Other non-surgical treatments might be added, such as electrical stimulation of muscles and nerves, ultrasound, or a cortisone injection near the inflamed area of the rotator cuff. If surgery is not an immediate consideration, exercises are added to the treatment program to build flexibility and strength and restore the shoulder’s function. If there is no improvement with these conservative treatments and functional impairment persists, surgery may be recommended.
Surgical repair of rotator cuff tears is best for younger patients, especially those with small tears, and individuals whose rotator cuff tears are caused by an acute, severe injury. This is most often done through a tiny incision into which a small scope (arthroscope) is inserted to observe the inside of the joint. Surgery leads to a high degree of successful healing and reduces concerns about the tear getting worse over time.
If you missed the previous articles about shoulder pain, you may read them online at HealthyCellsBN.com or call 309-664-2524.
For more information on any orthopedic problem, call 309-663-6461 to schedule an appointment with the board-certified physicians at McLean County Orthopedics or visit their website at www.mcleancountyorthopedics.com. Their new office is located at 1111 Trinity Lane in Bloomington.
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