Rotator Cuff

The rotator cuff is a set of tendons and ligaments that support the movement of our arms at the shoulder joint. Often referred to as SITS muscle with reference to the first letter of their names (Supraspinatus, Infraspinatus, Teres minor, and Subscapularis), its primary job is to keep the head of the upper arm bone firmly within the shoulder socket. It is also responsible for shoulder movement and shoulder joint stability.

Susceptible to injury, tendinitis, bursitis, and tears are common problems with the rotator cuff leading to pain and inflexibility in movement. Usually, a rotator cuff injury occurs in people who repeatedly perform overhead hand motions. It is commonly associated with occupations such as that of a painter, carpenter, weightlifters, cheerleaders, and sportsmen especially those who play cricket, baseball or tennis. Age is also a contributing factor to a rotator cuff injury.

While physical therapy provides relief in many cases, surgical intervention may be required if there are extensive rotator cuff tears.

Signs, symptoms, causes and treatment for the rotator cuff.

 

CAUSES AND RISK FACTORS

Rotator cuff injuries are usually a manifestation of a major injury to the shoulder or progressive degeneration of the tendon. Repetitive overhead lifting, sudden jerks to the joint, heavy lifting over a long period of time and development of bone spurs around the shoulder may cause damage or irritation to the tendon.

The following increases the risk of a rotator cuff injury:

  • Age: As one grows older, the risk of developing issues with the rotator cuff increases. Most people suffer from it over the age of 40.
  • Occupation: Construction workers and sportsmen are more likely to suffer from a rotator cuff injury than others on account of their occupation involving certain types of weight lifting and certain types of arm motions.
  • Family history: There is likely to be a genetic component to rotator cuff injuries as they are more widely seen in certain families.
SYMPTOMS
  • A rotator cuff injury is usually accompanied by a dull ache in the shoulder and a limitation in motion.
  • The pain often leads to disturbance in sleep, especially when you lie on the shoulder with the injury.
  • The limitation in motion does not allow you to reach for your back or perform actions like comb your hair.
  • Rotator cuff injuries are also accompanied by weakness in the arm of the affected shoulder.
DIAGNOSIS
  • Diagnosis of a rotator cuff injury is usually done via a physical exam of the shoulder comprising of the inspection, palpation, range of motion, provocative tests, neurological exams and strength testing.
  • Diagnosis also depends on family history, examination of tenderness and deformity of the shoulder and arm.
  • Diagnostic modalities like X-ray, MRI, MR arthrography and ultrasound are used depending on severity of the injury and other conditions.
  • An MRI is most commonly used to identify the size and location of the tear with reasonable accuracy. Ultrasounds allow for dynamic testing where the shoulder can be moved around while it is being tested. X rays help with detecting bone spurs or other causes of the pain like arthritis.
TREATMENT OPTIONS

Rotator cuff injuries have non-operative as well as operative treatment options. Those with pain but not too much of inflexibility in their movement are suitable for non-operative treatment. If the injury is severe, surgery might be considered.

Oral medication for pain relief and inflammation management are usually administered. Slings help with comfort and rest. Hot and cold packs are helpful too.

At Apollo Spectra, with its state-of-the-art facilities, rotator cuff injuries are not only well diagnoses but also treated effectively and efficiently at a reasonable price.

MEDICAL MANAGEMENT

Medically, rotator cuffs can be treated as follows:

  • Conservative treatments like rest, ice and physical therapy may be all that is needed to recover from this injury.
  • Doctors may recommend a steroid injection if you are not working. This is administered into the shoulder joint and should be used judiciously as they can cause the tendon to weaken.
  • Physical therapy helps with restoring flexibility and strength to the shoulder after the injury. It is also useful in eliminating pain and full function of the shoulder.
SURGICAL MANAGEMENT

The following surgeries, all offered at the Apollo Spectra, are standard procedures for treating rotator cuff injuries:

  • Arthroscopic surgery: Using a small incision, doctors insert a hi-tech camera and other instruments to reattach the tendon to the bone. This is a relatively pain free procedure which restores the patients’ normal anatomy. Small tears are usually operated like this.
  • Open tendon repair: In situations with larger tears, open tendon surgery may be a better option where the surgeon places a larger incision to reattach the tendon.
  • Bone spur removal: Bone spurs or overgrowth in the bones may cause irritation to the cuff and hence need surgery to be removed. The damaged part of the tendon can be smoothened. Usually performed arthroscopically.
  • Tendon transfer: If the tendon is too damaged, surgeons may use a nearby tendon for reconstruction.
  • Shoulder replacement: Very damaged tendons or rotator cuff injures warrant a full shoulder replacement.

At Apollo Spectra, rotator cuff injuries are analysed and treated by orthopaedic specialists alongside physiotherapists and radiologists. Multiple tests are done and the whole team comes together to discuss and decide an action plan, for every individual patient. On-going research helps these specialists come together and work to provide the patient with the best results.

FAQs

Are there any complications associated with rotator cuff injuries?

Without treatment, yes. It may lead to permanent stiffness or weakness along with progressive degeneration of the shoulder joints.

Is there any way to prevent rotator cuff injuries?

If you’ve had a rotator cuff injury before or are likely to suffer from one, it is advisable to do daily shoulder stretches and exercises. Ensuring you use proper technique while playing sports is important too.