Shoulder Rotator Cuff Injury

There are several different types of rotator cuff injuries. They can be either acute, caused by a particular incident such as a fall, or degenerative, which are caused by repetitive use over a long period.

As such, acute injuries are more likely to occur in younger age groups while degenerative injuries are more likely among athletes in sports such as tennis and baseball, and people whose jobs require repetitive lifting such as painters. Even routine chores at home can cause overuse and contribute to injury.

Injuries are also more common in those above 40 years as blood supply to rotator cuff tendons reduces with age, affecting the body’s ability to repair tendon damage. Bony spurs are also more common in older persons, the spurs rub against the rotator cuff tendon when the arm is raised, leading to tears.

Common ones include:

• Rotator cuff tendonitis is caused by irritation and swelling of the tendons of the rotator cuff muscles. This may be due to an injury or overuse of the shoulder. It can occur in athletes who take part in throwing sports or in non-athletes who do regular heavy lifting or activities involving repetitive movements of the shoulder.
• In rotator cuff impingement syndrome, the rotator cuff tendon becomes trapped and is repeatedly rubbed against the shoulder blade, leading to wear and tear of the tendon.
• Rotator cuff tears are tears in the rotator cuff tendon instead of the muscles. It often happens as a result of a fall or an accident in younger people. In older people, tears are usually caused by rotator cuff impingement syndrome.
• Bursitis is the inflammation of the fluid-filled sacs between the rotator cuff tendons and underlying bone.

If your shoulder pain is affecting your ability to perform certain activities or limiting your range of motion, especially when reaching overhead or behind your back, you may be experiencing some form of rotator cuff injury.

Some symptoms are characteristic of specific types of injury. For example:

• Rotator cuff tendonitis – generalised shoulder pain or pain that worsens with overhead activities or at night
• Rotator cuff impingement syndrome – chronic shoulder pain that worsens with overhead activities or at night
• Rotator cuff tear – pain and weakness in the shoulder
• Bursitis – pain that gets that worse with repetitive or overhead movement

To diagnose your injury, your doctor will need to examine your medical history, conduct a physical exam and recommend scans or X-rays which can help identify abnormalities and tears. They may also need to ask about your hobbies and work activities, and test your arm strength and range of motion.

As shoulder pain could also be caused by bone spurs rubbing against the tendon or arthritis, your doctor may need to rule these out before recommending the appropriate treatment.

Treatment varies according to the type of injury. Non-surgical treatment options to relieve pain and improve shoulder function include:

• Rest and limiting overhead activities and activities that cause shoulder pain
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Strengthening exercises and physiotherapy to restore movement and strengthen your shoulder
• Steroid injections

If the pain persists and does not improve with non-surgical methods, or if you actively use your arms for work or sports, your doctor may recommend surgery.

Depending on the type and extent of your injury, your doctor may perform one of these procedures:

• Arthroscopic tendon repair: this requires several small incisions, allowing the surgeon to insert a small camera and small tools to reattach torn tendon to the bone.
• Open tendon repair: some injuries may require a larger incision for the surgeon to reattach the tendon.
• Tendon transfer: in the event the torn tendon is too damaged for reattachment, the surgeon may use tendons from a nearby area instead to replace the damaged tendon.
• Shoulder replacement: significant injuries to the rotator cuff may mean that repair is not viable and the joint needs to be replaced.

Post-surgery, you will need to use a sling for several weeks to allow the rotator cuff to heal, and physiotherapy will be an important part of your recovery. With daily exercises and regular sessions with a physiotherapist, your shoulder strength and motion will gradually improve. For most patients, it will take around 6 months to resume normal activity.

Consult an orthopaedic surgeon to determine the treatment method most suitable for you.

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Complications can arise when treatment for rotator cuff injury is delayed. Persistent discomfort or pain may cause you to limit your movement. This can worsen the tightness or stiffness, and lead to a condition called frozen shoulder or adhesive capsulitis. Over time this can lead to permanent weakness or loss of motion, and progressive degeneration of the shoulder joint.

To minimise the risk of frozen shoulder, rotator cuff injuries should be diagnosed and treated promptly.