Rotator Cuff Injury

The rotator cuff is a group of muscles which work together to provide the Glenohumeral (shoulder) joint with dynamic stability, helping to control thejoint during rotation (hence the name). The rotator cuff muscles include:
• Supraspinatus
• Infraspinatus
• Teres Minor
• Subscapularis
Due to the function of these muscles, sports which involve a lot of shoulder rotation – for example, bowling in cricket, pitching in baseball, swimming, javelin throw,basketball,volleyball – often put the rotator cuff muscles under a lot of stress.
Problems with the rotator cuff muscles can be classed into two categories – Tears of the tendons/muscles, and inflammation of structures in the joint.

Acute Tear

Shoulder will be helped by:

• Rest the shoulder

• Ice can be used at least 3 times a day and is useful for the first couple of days following an injury

• Apply ice for no more than 15-20 minutes ensuring you use an appropriate ice bag, or wrap the ice in a towel to prevent ice burn

•  Warmth may be useful after the first few days to help with the pain

• Medication may be helpful to help control the pain – speak to your doctor if you think you require stronger than what you might usually take

Treatment for an Acute Rotator Cuff Tear

• Apply ice to reduce swelling as above

• Control the pain with appropriate medications

• Rest the arm – a sling can sometimes be quite useful if you still need to go to work/school, which can be removed at night

• You may require imaging studies (x-ray, MRI, CT Scan) to identify what the problem is and rule out any fractures

• Consider consulting a shoulder specialist who can advise you with rehabilitating the injury

If the injury is quite severe and you are young and active, you might require an operation to fix the tear.  This needs to be done within 3-6 weeks.  Indications include:

• Under 60 years old

• Complete tears of the tendon/muscle

•  Failure of other treatments after 6 weeks

• Professional/keen sports people

• If your job requires constant shoulder use

Treatment for a Chronic Rotator Cuff Tear

• Control pain

• Apply ice as above, heat may also be beneficial

• Sometimes you might be referred for an injection of steroid medication directly into the site of the problem to help reduce any inflammation and allow you to proceed with rehabilitation

• Shoulder exercises which can be provided by a physiotherapist at A+ clinics.

• You may require surgery, the indications as above

Treatment for Rotator Cuff Inflammation

• Apply ice initially as above

• Rest the arm for short periods, but it is important to keep the shoulder moving to prevent stiffness and further reduced movement.

• You may benefit from a course of anti-inflammatory medications

• You may need to have an injection of steroid medications directly to the site of the inflammation, as explained above.

• Heat and massage may help once things start to improve a bit

• Small pendular movements when leaning forwards may provide some relief and help to improve the shoulder movement.  Consult with a physiotherapist at A+ clinics for a personalised exercise plan.

• Walking your fingers up a wall or door can help to improve shoulder movement.  Also, holding a stick with both hands and using the better shoulder to move in a circular fashion can help, as this moves the painful shoulder with minimal stress on the rotator cuff muscles

How long will it take to get better?

• Depending on several factors, conservative treatment has a 40-90% success rate at fixing the problem.

• Surgery often has good results, with some studies citing a 94% satisfaction rate with the surgery, resulting in lasting pain relief and improved function.  Very extensive tears often have a poor surgical outcome, however this injury is thankfully quite rare.

If you are older, it will take you longer to heal due to differences in your physiology.

Subacromial Bursitis

The supraspinatus muscle runs along the top of the shoulder blade and inserts via the tendon at the top of the arm (humerus bone). This muscle is used to lift the arm up sideways and is also important in throwing sports as it is the muscle that holds the arm in the shoulder when you release what you are throwing. There are massive forces involved in slowing the arm down after you have thrown something but few people bother to train these muscles. A heavy fall onto the shoulder can also result in injuring this muscle.

Over the tendon is a bursa (small sack of fluid used to help lubricate the moving tendon). This bursa can become trapped in the shoulder causing pain and inflammation.
The athlete is more prone to this injury if they overuse the shoulder particularly if the arm is at or above shoulder level. Or if the athlete has had a rupture of the supraspinatus tendon.  

Symptoms include:

• Pain and weakness when the arm is lifted up sideways through a 60 degree arc.

• Pain when you press in at the inside front of the upper arm.

• If it is the tendon that is injured rather than the bursa there is likely to be more pain when the arm is lifted up sideways against resistance.

What can the athlete do?

• Rest until there is no pain.
• They must however continue pain free mobility exercises to keep the full range of movement in the shoulder.
• Apply heat and use a heat retainer.
• See a sports injury specialist or doctor who can advise on rehabilitation.

What can a sports injury specialist or doctor do?

• Prescribe anti-inflammatory medication such as ibuprofen
• Prescribe a full rehabilitation programme.
• Operate with persistent problems.
• If it is bursitis the doctor can aspirate (stick a needle into the bursa and suck out the extra fluid).