A rotator cuff covers a front, rear and upper surface of the glenohumeral joint. Its structure is made of four shoulder girdle muscles: supraspinatus muscle, infraspinatus muscle and teres minor muscle. Its main task is to stabilize a head of the arm bone in the joint, lift the arm and rotate movements in the joint. The rotator cuff damage is one of the most frequent conditions of the shoulder joint. The structure gets damaged as a result of the injury or progressive degenerative changes to the tendon or its attachments. This damage causes pain and instability of arm joint. It is most often sustained by persons aged 40 upwards as well as young people who do sports.
Rotator cuff damage – causes
The rotator cuff damage may arise from degenerative changes to tendons and shoulder girdle muscles. This being the case, the damage is chronic, initially without noticeable complaints. Both in sport and at work the injury of this sort may be sustained as a result of taking recurring actions in which we lift our arm. Speaking of sportspersons, sports which require us to raise our arms high are the most exposed, that is volleyball, basketball, handball, tennis and swimming. The same applies to workers who have to raise their hands in their everyday duties, e.g. paining ceilings, works at the construction site, etc. The rotator cuff damage may be acute as a result of the injury, e.g. falling on a straight limb or lifting a weight and rotating the arm the same time. Another type of the tendon damage is calcification. The inflammatory process causes calcium deposits to accumulate inside the tendon, which leads to acute pain, and weaken its endurance.
– sudden damage – related to sports
– chronic damage – arising from degenerative changes
Rotator cuff damage – symptoms
- Pain and limited movements in the joint, weaker muscles in the shoulder area;
- Pain when taking physical activities;
- Shoulder pain may occur suddenly (e.g. after lifting a weight or twisting arm) or intensify gradually;
- Pain may occur when taking certain actions, particularly when lifting arm, e.g. reaching a high shelf, working with hands up;
- Pain may also occur at night and disturb sleep;
- Sometimes shoulder cracks and clicks.
Rotator cuff damage – diagnosis
The basis for diagnosing a rotator cuff damage – according to PhD MD Joanna Niemunis Sawicka (a Rehasport Clinic radiologist in Gdańsk) – is the medical history, clinical testing and imaging examination. Imaging examinations encompass ultrasound scanning, magnetic resonance examination and X-ray scans. The ultrasound examination shows detailed damage to rotator cuff tendons, and importantly it can be performed dynamically when moving an arm. Thanks to the examination, it is possible to qualify the damage to partial or total tendon ruptures, expose the exact place of damage and accompanying other types of damage in the arm. A key advantage of ultrasound examination is a possibility of conducting a comparative assessment with the opposite arm at the same time, evaluating the sick arm in motion and giving a medicament in a specific place.
MR is equally precise in showing the rotator cuff pathology and biceps long head of the tendon, and additionally lets us evaluate all joint surfaces and structure of arm bone. Thanks to MR, it is possible to evaluate the area of arm vessels and nerves precisely as well as examine the morphology of rotator cuff muscles. X-ray scanning in turn may be helpful in the process of excluding other causes of similar complaints or accompanying damage, i.e. calcification, injury changes or degenerative changes. We must remember however that imaging examinations devoid of clinical tests are not sufficient to make a full diagnosis.
Rotator cuff damage – treatment
Rotator cuff damage – says PhD Maciej Pawlak from Rehasport Clinic in Gdańsk – can be divided by patomechanism. On the one hand they may get damaged as a result of injuries, which applies primarily to young and active people, on the other due to degenerative changes. It is a way more frequent issue than rotator cuff traumatic injuries. A degenerative changes to rotator cuff tendons are sustained by every second patient who turned 70 years of age. It is an important fact because many patients who suffer from degenerative damage cannot see any symptoms, they live normally and their shoulder works well. This shows that such rotator cuff degenerative damage may prove that the organism ages, wears out, just like joint degeneration. These patients must not undergo surgical treatment. What must be treated surgically is rotator cuff damage, traumatic or degenerative, which cause typical symptoms, such as pain, limited mobility or weaker muscle strength.
At present the golden means in the process of treating rotator cuff damage is arthroscopic treatment with the use of camera. The tendon is sewed to the larger nodule again, that is the place from which this tendon tore off. To do so, special fixing implants are used. The recovery period varies and widely depends on whether we deal with a young person whose rotator cuff ruptured due to a fall, or an older person who suffer from cuff degeneration.
Shortly after the surgery, a hand is immobilized to create best conditions for integrating the tendon with the bone. The immobilization period may range from 4 to 6 weeks. Next the rehabilitation treatment and rehabilitation start to last usually half a year.
Certainly it is possible to return to doing sport if you suffer from rotator cuff damage. This injury applies primarily to the so-called throwing sportspersons, such as handball players, volleyball players or tennis players and lets them return to previous sports after they have undergone a surgical treatment.
Rotator cuff damage – rehabilitation
The rotator cuff damage rehabilitation – says MA Zuzanna Kulczyńska a physiotherapist from Rehasport Clinic in Gdańsk – can be divided into post-surgical and conservative.
– The post-surgical rehabilitation commences in the first week that follows the surgery. First 4-6 weeks are focused on protection of the spot in question. A physiotherapist is responsible for reducing the muscle tension in the area of shoulder girdle, working on post-surgical scars, adapting exercises in which the movement is maintained at 90* of bend in the arm joint, controlling the proper posture. After the protection period exercises which increase the range of movement in the joint and strengthen muscles of the shoulder girdle are incorporated. The manual work is kept in order to limit pain, reduce tension in the area of myofascial structures of the shoulder girdle which arise from the immobilization, improvement of mobility in the joint.
The rehabilitation varies. It depends on numerous factors such as patient’s condition before the surgery, pain, limited range of movements and age. The entire rehabilitation takes about 6 months. At this time rehabilitation is adapted on a case-by-case basis. The last stage of rehabilitation is concerned with restoring full physical loads with proper work of shoulder girdle.
– The conservative rehabilitation is introduced if for some reason the surgery is not recommended or when the doctor decides to use the conservative treatment based on the patient examination. This kind of rehabilitation lasts usually about 6 months. Rehabilitation is intended to reduce pain, increase the range of movements, strengthen muscles of shoulder girdle and above all mobility biomechanics. In this case, similar to post-surgical rehabilitation, exercises are adapted on a case-by-case basis. A physiotherapist, depending on patient’s needs, works with the patient manually in the myofascial structures of the shoulder girdle and arm joint.
Rotator cuff damage – examples of exercises
Shoulder girdle dorsal part strengthening exercises
Arm joint rotating muscles strengthening exercises
Side support arm joint rotating muscles strengthening exercises
Front support arm joint rotating muscles strengthening exercises
Front support arm joint rotating muscles strengthening exercises