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    Shoulder and Elbow - Rotator Cuff Injuries

    Overview
    Causes
    Symptoms
    Diagnosis
    Treatment
    Where to Seek Treatment
    Return to Shoulder and 
        Elbow Injuries
    Singapore General Hospital
    Contributed by Dept of Orthopaedic Surgery

    Overview

    The rotator cuff comprises a group of 4 muscles that function to stabilise and move our shoulders. Though the rotator cuff muscles are extremely important structures in the shoulder, they are also prone to tears and weakening.

    A rotator cuff injury, which is fairly common, involves any type of irritation or damage to your rotator cuff muscles or tendons. The risk of injury increases with age, and is particularly common in middle-aged persons.


    Causes

    Normal wear and tear
    As the tendon of the rotator cuff has poor blood supply, it tends to be prone to degeneration due to ageing. The degeneration can be aggravated by repetitive shoulder movements. Hence this condition typically occurs if you are above 40.

    Repetitive movements
    Athletes who regularly use overhead repetitive movements such as swimmers, rowers or tennis players are at higher risk of rotator cuff injuries. However, the injury can also happen through seemingly trivial activities like carrying a heavy load, lifting things overhead or hanging the clothes out.

    Trauma
    The rotator cuff can also be damaged from a single traumatic injury such as a fall or a hard direct hit to the arm.

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

    Poor posture
    Slouching forward of the head and neck can cause the muscle or tendon to be pinched leading to inflammation.


    Symptoms

    In many people with underlying rotator cuff injury, they can often have no pain or limitation of motion though they can have inflammation or early injury to their rotator cuff resulting from degeneration with chronic overuse from repeated usage. These patients often present only after an injury, like a fall which causes a tear in the already injured rotator cuff.

    When there is a tear in the rotator cuff , the most common symptom is pain in the shoulder especially when lifting the arm. Pain may be experienced when you reach up to comb the hair, or bend the arm back to wear a piece of clothing.

    You can also experience weakness, and tenderness in the shoulder and pain when sleeping on affected arm. The shoulder can also experience a loss of range of motion. With a large tear, there can be continuous pain and muscle weakness.

    In cases of a complete tear of the rotator cuff, there is likelihood that you may completely be unable to lift the arm.


    Diagnosis

    Diagnosis of a rotator cuff tear is based on history and clinical examination. X-rays may be useful in determining if there are other contributing factors such as previous bony injury.

    An ultrasound or MRI will show if a tear is present as it can identify all rotator tears from degeneration to partial or complete tears.


    Treatment

    Generally, pain relief medication would be the first line of treatment. A steroid injection can be given to relieve pain and inflammation.

    Physiotherapy is recommended to increase shoulder muscle strength and improve flexibility.

    Surgical options include arthroscopic (Arthroscopy) or key-hole repair. The torn edge of the cuff is removed and mobilised. The tendons are reattached to the bone using absorbable or metal anchors using the latest technique available. Traditional open repair of the rotator cuff can also be performed. After surgery, patients are put in a sling or brace. Therapy starts the day after surgery.

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