The (glenohumeral joint) shoulder is made up of muscles, ligaments, tendons and three bones. The shoulder has been described as an unstable golf ball (head of the upper arm) sitting on a golf tee (shoulder socket). The problem in the shoulder lies in that it must be mobile enough for the wide range of actions of the arms and hands, but also stable enough to allow for actions of everyday life such as lifting, pushing and pulling. The rotator cuff is a group of four muscles and tendons that surrounds the shoulder joint, keeping the head of your upper arm bone firmly within the shallow socket of the shoulder. The strength of the cuff allows the muscles to lift and rotate the upper arm. The rotator cuff muscle/tendons can become torn, leading to pain and restricted movement of the arm following trauma to the shoulder or “wear and tear” on tendons. Rotator cuff injuries are commonly associated with motions that require repeated overhead motions or forceful pulling motions such as in baseball, football, painting and carpentry. Rotator cuff injuries can also occur after using your arm to break a fall, lifting an object that’s too heavy or having an overgrowth of bone on the shoulder blade. Prevention aims at avoiding excessive overhead activities and strengthening your shoulders and core musculature. Relearning to use your hips properly while undergoing shoulder activities will greatly reduce the stress on the shoulder and rotator cuff.

When the tendons or muscles of the rotator cuff tear, the patient is no longer able to lift or rotate the arm with the same range of motion as before the injury and/or has significant pain associated with shoulder motion. The most common symptom of a rotator cuff problem is pain. The pain associated with a rotator cuff injury may be described as a dull ache deep in the shoulder and may disturb your sleep if you lie on the affected shoulder. Some rotator cuff injuries may be accompanied by weakness and may make it difficult to comb your hair or reach behind your back. The risk of rotator cuff injuries increases with age.

Rotator Cuff tears are usually classified as either a partial tear or full thickness tears. A partial thickness rotator cuff tear is an incomplete tear of the rotator cuff muscle or tendon. These may be traumatic in athletes and are known as PASTA lesions. A majority of partial thickness tears are seen in people over the age of 50 and may be chronic or related to minor trauma, such as a simple fall. Full thickness tears may involve only part of one tendon and may extend to become massive tears. Massive rotator cuff tears are usually classified as tears greater than 5cm in size and involve at least 2 muscles of the rotator cuff.  A massive tear is unusual in a patient under 60 years old and are much more common in older people

A physician diagnoses rotator cuff disease by reviewing the patient’s history performing a thorough physical examination of the joint and taking the proper X-rays and imaging studies (shoulder ultrasound or MRI)

Treatment for your rotator cuff injury depends on the extent of the injury and physical examination findings. A treatment plan incorporating stretching, strengthening, mobilization, nutrition and kinesiotape will be utilized for most patients. Anti-inflammatory medication such as ibuprofen or naproxen should be taken with care, but may help decrease the pain and swelling in the acute phase. Cortisone injections reduce inflammation and help control the pain but it is advisable to avoid repeated steroid injections in the presence of a tendon tear, as this may weaken the tendon further. If you do not respond to conservative treatment, surgery may be done arthroscopically (keyhole) or open, or a combination of the two, known as a mini-repair.

Dr. James Andrews, a widely known sports medicine orthopedist in Gulf Breeze, Fla., wanted to test his suspicion that M.R.I.’s, the scans given to almost every injured athlete or casual exerciser, might be a bit misleading. So he scanned the shoulders of 31 perfectly healthy professional baseball pitchers. The pitchers were not injured and had no pain. But the M.R.I.’s found abnormal shoulder cartilage in 90 percent of them and abnormal rotator cuff tendons in 87 percent. “If you want an excuse to operate on a pitcher’s throwing shoulder, just get an M.R.I.,” Dr. Andrews says.



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