A Family Doctor's Tale - ROTATOR CUFF INJURIES

DOC I HAVE A ROTATOR CUFF INJURY


Rotator Cuff Injuries is a common disorder of the shoulder characterized by the injury and damage to the rotator cuff muscles or tendon resulting in pain and restriction of movement.

The rotator cuff muscles consists of 4 muscles that are used to stabilize the shoulder and move the shoulder.

It is more common in people above the age of 40.

The risk of injury increases with age.

The causes of Rotator Cuff Injuries are:
Several conditions has been blamed:
1.Repetitive movements of the shoulder- Swimmers, rowers and tennis players who use repetitive movements are at higher risk of rotator cuff injuries.

2.Heavy lifting or pulling:lifting and pulling an object that is too heavy or lifting in the wrong way can cause a strain or tear to the rotator cuff muscle or tendon.

Household tasks such as carrying a heavy load, lifting things overhead or hanging the clothes out may also cause rotator cuff injury.

3.Normal wear and tear- with age the blood supply to the tendons of the rotator cuff muscles is reduced resulting in degeneration of the cuff muscles and tendons.
This degeneration can be aggravated if there is repetitive shoulder movements resulting in a tear in the tendons or muscles.

4.trauma - injury to the rotator muscles such as a fall or direct hit to the shoulder muscles may cause a tear in the muscles resulting in tightening of the injured muscles around the shoulder joint.

5.Poor posture. Sloughing forward of the head and neck cause the rotator muscles to be strained leading to inflammation and tears.

Symptoms:
1.Pain in the shoulder when lifting the arm

2.Pain can occur when trying to comb the hair

3.Certain movements makes the pain worse

4.weakness and tenderness of the the shoulder with pain when sleeping on the affected arm

5.complaints of stiffness of the shoulder and loss of range of movement of the shoulder

6.inability to wear a shirt or blouse because of restricted movements

Signs:
1.apprehensive patient who holds the arm protectively

2.Generalized tenderness of rotator cuff

3.Limited shoulder movement

4..Range of muscle movement is reduced in all directions

Diagnosis:
1.history of a fall or injury followed by limitation of movement of the shoulder

2.Ultrasound and MRI will show if there a tear is present as it can identify all rotator tears from degeneration to partial or complete tears

The Treatment of Rotator Cuff Injuries are:
Conservative treatment:
1.rest of the shoulder

2.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain

3.Muscle relaxant to relax muscles

4.injection of local anesthetic and long acting steroid into the rotator cuff muscle may help to relieve pain.

5.Physiotherapy such as traction, shortwave diathermy help to increase shoulder strength and improve flexibility

6.gradual mobilization and exercises to loosen the tight muscles surrounding the shoulder

Surgery is usually indicated in Rotator Cuff Injuries if the condition does not improve with conservative treatment.

A keyhole or arthroscopic repair is done to remove the torn edges of the cuff muscles and retach them to the bone using absorbable or metal anchors.

After surgery patients are put in a sling or brace.

Physiotherapy starts the day after surgery.

Prognosis depends on the underlying cause.

In most cases Rotator Cuff Injuries may resolve itself with conservative treatment