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Rotator Cuff Disease

A drawback of traveling is carrying your suitcase everywhere, particularly lifting it into overhead compartments on planes, trains and buses. This really hurts my shoulder. Apparently, I am straining my rotator cuff muscles and tendons. As we age, these soft tissues surrounding the shoulder tend to weaken and are easily injured.

Here is short summary on Rotator Cuff Disease, published in Aches & Joints.



Primary Cause of Shoulder Pain and Treatment Options.

There are several causes of shoulder pain. In the elderly, shoulder pain is commonly associated with aging and can be traced to rotator cuff disease. In younger people, it is associated with throwing or overhead sporting activities that result in injury to the rotator cuff.

shoulder rotator cuff anatomy disease

The rotator cuff is a band of four muscles and tendons at the shoulder joint, which grasp the end of the upper arm or humerus (HYU-mer-us, see figure), much like four fingers holding a baseball. The rotator cuff thus stabilizes the shoulder joint and provides exceptional mobility to the arm. Pinching, irritation, or tears of the rotator cuff are common causes of shoulder pain.

shoulder rotator cuff anatomy holding baseball


Impingement
Rotator cuff tendons are separated from overlying bones by a soft tissue sac or bursa, allowing them to glide easily. According to one theory, repetitive motion of the arm causes pinching of this sac in the tight space between the acromion (a-KRO-me-un) and humerus (see figure), resulting in irritation, swelling and pain. This inflammation of the bursa and tendons is called impingement. The pain is characteristically worse when the arm is lifted and common at night.

Causes and Symptoms
The rotator cuff is frequently damaged by age related degeneration of the tendons. With advancing age, the blood supply to the rotator cuff diminishes, leading to weakness in the tendon and a decreased ability to repair micro tears occurring from every day use. Eventually a tear can develop. Of the four rotator cuff muscles, the supraspinatus (SOUP-ra-spin-ATE-us) is most frequently involved. Rotator cuff tendons can also be injured by constant rubbing across a bone spur.

Common symptoms include shoulder pain radiating to the neck or the arm. Pain increases while reaching overhead or behind the back, lifting, pulling, or sleeping on the affected side. Weakness of the arm is a common complaint. Most patients are able to perform activities required for daily living. However, patients with full thickness tears may be limited in their activities due to pain and weakness.

Diagnosing Rotator Cuff Disease
During a physical exam, the doctor will ask patients to perform various activities with their arm. Careful evaluations help the doctor diagnose impingement or rotator cuff tears. If your doctor suspects a tear, additional tests may be necessary to confirm and distinguish between a partial or complete tear.

An injection with a local anesthetic (eg lidocaine) can help the doctor distinguish between impingement syndrome, rotator cuff tears and other conditions, which mimic these. Radiographs can reveal signs of arthritis, fractures and bone spurs on the acromion causing irritation. Radiographs also reveal changes in position of the humerus and acromion suggestive of rotator cuff tears. However, radiographs cannot be used to visualize the rotator cuff itself or the underlying bursa, and advanced soft tissue imaging is frequently required. MRI is well suited for imaging soft tissues and to specifically evaluate the rotator cuff and the general shoulder.

Conservative Treatment May be Effective
Treating rotator cuff disease depends on the severity of symptoms and functional activity requirements. Dr Thomas F Holovacs, shoulder surgeon at the Massachusetts General Hospital and member of the Harvard Shoulder Service states, “a majority of patients will benefit from resting the shoulder, applying ice and using non-steroidal medications such as ibuprofen and naproxen to reduce pain. Subacromial injections of local anesthetic and corticosteroids can be effective in reducing shoulder inflammation.” A change in activities is often required.

Depending upon the type and level of injury, your doctor will coordinate with physical therapists and develop a customized protocol to strengthen the rotator cuff tendons and help you regain range of arm motion.

Some Patients May Need Surgery
A small percentage of patients with impingement, whose symptoms have not improved after conservative treatment, may benefit from minimally invasive surgical intervention. Using arthroscopic techniques performed through small ports in the shoulder, the irritated and inflamed bursa sac is removed, relieving pain and restoring function. During the procedure, the acromion bone is often smoothened to prevent impingement from reoccurring. Some surgeons believe that impingement is a sequelae of rotator cuff weakness, and in the case of a full-thickness rotator cuff tear, repairing the torn tendon is sufficient to relieve impingement.

Conservative treatments are less effective in patients with large rotator cuff tears, and in those with significant weakness in the arm and shoulder, hindering daily activities.
Often rotator cuff tears can be repaired using arthroscopy, a minimally invasive procedures. Successful repair reduces pain, and improves function and strength in greater than 80% of patients. Infection due to surgery and permanent stiffness remain complications in a small fraction of patients.

“Rotator cuff disease continues to plague our society for a variety of reasons including increased participation in sports and aging of our population. Frequently, rotator cuff disease can be managed conservatively. When conservative measures fail, arthroscopic surgery is a minimally invasive technique designed to return the patient to a painless, full, active lifestyle” adds Dr Holovacs.



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Comments

  1. Thank you Navin for sharing your positive view.

    I think for laptops, the backpack seems to be the way to go. I have seen a lot of folks use the one with wheels, and they love it! But it may not be ideal for all cities 🙂

    Best Wishes
    Arun

  2. That was very interesting and useful insight. I have decided to trade my laptop bag which I normally sling over my shoulder for a laptop backpack. 🙂

  3. Cold Compression Shoulder Wraps are an easy and helpful tool in relieving pain and aiding healing of a torn rotator cuff.

    Arun Says:
    Thanks for sharing the tip.

    Cold Compression will certainly help relieve pain and is well recommended, but I don’t think it does anything to the healing. It is likely that once the pain has subsided, activity can resume.

  4. Sudeepta:
    Yaaaay! Must have been great to attend a regular clas after so may years! Yes, our poses ‘drift’ and it is always good to have a refresher course!

    I think many of the standing poses like the warrior poses, the triangle pose, etc., benefit the shoulder passively by stretching and building strength! Even adho mukHa SHvanasa (downward facing dog) stretches and helps the shoulder directly.

    Many of the advanced poses such as the shoulder stand and dolphin pose require fit shoulders and help keep it that way!

    Glad you attended a refresher!

    Now, I have to attend this weekend; have not gone for yoga in a month, since I was in mumbai 😦 Looking forward to it.
    Arun

  5. I went for a “fundamentals of yoga” class last weekend for a change – its so amazing to go back to basics and relearn some things that you forget when you get to the advanced classes. I can think of a lot of poses that would be really helpful for this injury – gentle and stress-relieving…

  6. Thanks a lot for this article.. With the diagram it was easier to understand. My dad had some trouble a couple of years back in even lifting his arm. He is a teacher by profession and had trouble with writing on board. Docs said that it was due to frozen muscles. He underwent ayurvedic treatment and with regular exercises he is fit and fine.
    I will send this across to dad too 🙂 Thanks a lot Arun. I need to ditch my huge handbag now! BTW is there any way this could be prevented?

    Arun Says:
    Thank you for sharing that Ujjwal.
    Glad to work your father’s shoulder pbs were solved with ayurveda and exercises. Here, we havea lot of arthroscopic surgery and frankly the results are very mixed. I think the shoulder anatomy is sufficiently complex and we are still grappling with what the causes are of many shoulder ailments like frozen shoulder.

    Yeah, try a across the chest satchel, or a very light handbag!

    Best!

  7. Glad this was of use to you, Saroj!
    Yeah definitely get rid of the weight; or carry an across the chest satchel (though it could be a fashion disaster!).

    and some yoga helps loosen the shoulder.
    🙂

  8. sospokesaroj says:

    Ahh thanks for this article and the diagram with the musculature in question (yay anatomy lesson!). Perhaps I should rethink the huge tote bag in favor of something less taxing on my shoulder.

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  1. […] is essential for performing activities in a pain- and injury-free manner. See related article on Rotator Cuff complications impairing shoulder […]

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