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Rotator Cuff: Causes, Symptoms, Diagnosis, Treatment, and Prevention

A rotator cuff is a group of four muscles and tendons that surround the shoulder joint, holding the upper arm bone firmly within its shallow socket. As well as providing stability to the shoulder joint, the rotator cuff allows the shoulder to move in different directions.

Causes of Rotator Cuff Injury

A rotator cuff injury can occur from either an acute trauma or a chronic degeneration of the tendon tissue. Some of the common causes of rotator cuff injury are:

• • Repeated overhead motions, such as painting, carpentry, or sports like tennis and baseball, that can irritate or damage the tendon over time.

  • A sudden fall, accident, or collision that can tear the tendon or cause a shoulder dislocation.

  • Aging, which can weaken the tendon and make it more prone to injury.

  • Bone spurs, which are overgrowths of bone that can rub against the tendon and cause inflammation or tearing.

Symptoms of Rotator Cuff Injury

The symptoms of a rotator cuff injury may vary depending on the severity and location of the damage. Some of the common symptoms are:

• • A dull ache in the shoulder that worsens at night or when lying on the affected side.

  • Difficulty raising the arm above the head, reaching behind the back, or performing daily activities that require shoulder movement.

  • Pain that radiates from the shoulder to the arm or neck.

  • Weakness or numbness in the arm or hand.

  • A popping or clicking sound when moving the shoulder.

Diagnosis of Rotator Cuff Injury

During a physical examination, a doctor will ask about the history and onset of the symptoms to determine if there has been a rotator cuff injury. Additionally, the doctor will assess the shoulder joint's range of motion, strength, and stability. Also, the doctor may order one or more imaging tests in order to confirm the diagnosis and assess the extent of the injury:

• • X-ray, which can show bone spurs or other potential causes of shoulder pain, such as arthritis, but cannot detect a rotator cuff tear.

  • Ultrasound, which uses sound waves to produce images of the soft tissues of the shoulder, such as the muscles and tendons. It can show the location and size of a rotator cuff tear and how it affects the shoulder movement.

  • Magnetic resonance imaging (MRI), which uses radio waves and a strong magnet to create detailed images of the shoulder structures. It can reveal the condition of the rotator cuff, as well as any other injuries to the ligaments, cartilage, or bone.

Treatment of Rotator Cuff Injury

The treatment of a rotator cuff injury depends on the type and severity of the injury, as well as the age, activity level, and general health of the patient. The treatment options may include:

• • Rest, ice, heat, anti-inflammatory medications, corticosteroid injections, and physical therapy are conservative treatments. A mild to moderate injury or a patient who is not a candidate for surgery can benefit from these treatments because they reduce pain, inflammation, stiffness, and improve flexibility and strength.

  • Surgery, which may be necessary for severe or chronic injuries that do not respond to conservative treatments or impair the shoulder function. There are different types of surgeries for rotator cuff injuries, such as:

    • Arthroscopic tendon repair, which involves inserting a small camera and instruments through tiny incisions in the shoulder to reattach the torn tendon to the bone.

    • Open tendon repair, which involves making a larger incision in the shoulder to access and repair the damaged tendon.

    • Tendon transfer, which involves using a nearby tendon to replace a severely damaged or irreparable tendon.

    • Shoulder replacement, which involves replacing the damaged shoulder joint with an artificial one.

    • Bone spur removal, which involves removing the overgrown bone that rubs against the tendon and causes pain.

The recovery time and outcome of the surgery depend on the type of surgery, the extent of the injury, and the patient’s compliance with the postoperative care and rehabilitation.

Prevention of Rotator Cuff Injury

To prevent or reduce the risk of a rotator cuff injury, some of the measures that can be taken are:

• • Performing shoulder-strengthening exercises regularly to maintain the muscle and tendon health and prevent weakness and stiffness.

  • Warming up properly before engaging in any activities that involve overhead or repetitive shoulder motions, such as sports, work, or hobbies.

  • Avoiding or modifying activities that cause shoulder pain or discomfort, and taking breaks to rest the shoulder when needed.

  • Using proper techniques and equipment when lifting, throwing, or reaching overhead, and avoiding sudden or excessive force or movements.

  • Eating a balanced and nutritious diet that supports the bone and tissue health and prevents inflammation.