Shoulder Rotator Cuff Pain: Treatment Options

Introduction

Rotator cuff tendonitis and tears are common disorders of some of the muscles that control movement of the arm and shoulder. Rotator cuff tendonitis and tears are collectively known as Impingement Syndrome.

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A rotator cuff injury includes any type of irritation or damage to your rotator cuff muscles or tendons. Causes of a rotator cuff injury may include falling, lifting and repetitive arm activities, especially those done overhead, such as throwing a baseball or placing items on overhead shelves.

What is a Rotator Cuff Tear in the Shoulder?

Before any injury to the rotator cuff can be explained, the functions of the rotator cuff must be detailed first. A rotator cuff tear in the shoulder is a common injury. Because the shoulder is used constantly in many activities that require effort in pulling, pushing and lifting motions, it is very possible to cause a tear in the rotator cuff.

A rotator cuff tear basically means one of the rotator cuff tendons has been injured. The rotator cuff tear's appearance usually varies in shape and size. However, it is usually associated with a hole in one of the rotator cuff tendons. This tear or hole is usually attributed to one of two things. It is caused by either a traumatic injury or repetitive use injury.

Rotator Cuff Traumatic Injury

When a rotator cuff tear is brought on by a traumatic injury, it simply means the tear happened as a result of a physical event or activity. Normally, this occurs when a person falls or when a person has a very strong collision with a hard object.

Since this type of rotator cuff injury happens due accidents, they are not as common as repetitive use injuries. Moreover, younger and more athletic people are prone to this form of rotator cuff tear.

Rotator Cuff Repetitive Use Injury

In a repetitive use injury, the rotator cuff tear in the shoulder is caused by gradual wear and tear on the tendons. This injury comes as a result of years of frequent use of the rotator cuff muscles.

A repetitive use injury of the rotator cuff is especially applicable for people who do a lot of overhead motions with their arms. This can be seen in people whose job involves stacking high shelves and in sports like tennis, rowing and baseball. This form of injury is more prominent in older people, especially for those who are over 40 years of age.

Symptoms of a Torn Rotator Cuff

The most common and obvious symptoms of torn rotator cuff is pain. Pain is often felt at the top and outer or back side of the shoulder. However, the pain can sometimes radiate and it may be felt throughout the arm. The pain will also be intensified whenever the person raises or swings his arm.

In some cases, the pain can be greater during sleep. This is because when sleeping, people often unknowingly put pressure or weight on the injured shoulder. Since the rotator cuff is torn, the person will consequently feel weaker in the arms. An X-ray or an MRI can help effectively diagnose any tear in your rotator cuff.

Another symptom of torn rotator cuff is when you feel pain or you experience difficulty in normal activities. If you feel pain when combing, dressing or reaching behind your back, you might have a minor tear in your rotator cuff. Ask your doctor for further tests to confirm your condition. If you are worried about a tear in your rotator cuff, be mindful of your range of movement. If you notice you cannot move your shoulder normally or have difficulty lifting or swinging your arms, seek medical attention at once.

Unusual sounds can also be indicative of a torn rotator cuff. If you hear your shoulder 'pop' whenever you lift it overhead or when you bring it down, there may be an injury to your rotator cuff. Also, if there are cracking or grating sounds whenever you move your arm, you may have a tear in your rotator cuff.

Keep in mind that the symptoms of a torn rotator cuff may appear gradually, especially if the injury is due to overuse. You may have developed a tear but the pain and other symptoms may appear much later and sometimes, when the tear has worsened.

If the torn rotator cuff results from a fall, the symptoms may be felt immediately. After a fall or a collision, the person may feel like his shoulder snapped or suddenly weakened. There will be sudden onset of acute pain.

Can a Torn Rotator Cuff Heal?

Of course. A torn rotator cuff can definitely be healed provided the injured person seeks medical attention immediately. If you simply ignore the injury, treatment options will be more serious and more complicated.

There are non-surgical treatment options that can heal a torn rotator cuff. These options are fairly simple and would help give the injured person some much-needed pain relief. These treatment options will also improve the range of movement of your shoulder.

Non-surgical treatment options include rest. While this may be a simple solution, rest is crucial since this prevents the tear from getting any worse. A person with a torn rotator cuff should limit any overhead movement of the arm. They should also avoid lifting any sort of weight on the injured arm. Using a sling will help the person prevent any unnecessary movement and stress on the shoulder. With adequate rest, the rotator cuff may heal much faster.

Physical Therapy is another way of helping the rotator cuff to heal properly. This step will help develop strength in the rotator cuff so it will be less susceptible to injuries. Therapy, coupled with ant-inflammatory medications will help alleviate pain. Cortisone injections will help make any swelling subside so therapy can proceed immediately.

If these methods do not alleviate the pain, surgery may be an option. Surgery is also recommended for people who injured the rotator cuff on their dominant arm. For athletes and other people whose arm movements are extremely relevant in their line of work, surgery can help restore full strength and motion.

The condition of the rotator cuff tear will determine the type of surgery you need to have. If the thickest part of the tendon has a complete tear, the surgery you will have entails stitches that will bring the sides of the tendon back together.

If your tear is more severe and the tendon has been torn from where it is attached from the humerus, your surgeon will have to re-attach it. However, if you have a small tear, all you need is the trimming procedure or debridement. Once the surgery is completed, the arm must be immobilized for a certain amount of time. So can a rotator cuff heal? Certainly it can.

Should I Continue Exercise with a Torn Rotator Cuff?

That depends on the severity of the rotator cuff injury.

Fact is, rotator cuff injuries heal slowly because the tendons in the shoulder area receive little blood supply. (Ergo, making it vulnerable to degeneration, and this deterioration is one of the causes for rotator cuff injuries.) Anyway, the body can heal, but it can only do so much. A completely severed tendon usually requires surgery. With this said, treatment can be of two kinds: non-surgical and surgical.

Treatment and recovery depends highly on the gravity of the injury. Most athletes who suffer from partially torn tendons need not undergo any surgery. A little rest, ice and physical therapy (RIP) will be sufficient.

Rest: Rest, is the first step to allow the swelling and pain to recede. Do not go back to work or do a physical activity without first consulting with your doctor.

Ice: Ice help's subside the pain and swelling.

Physical Therapy: Most rotator cuff injuries are effectively treated with simple exercises intended to re-establish or bring back muscle strength. Talk to your physiotherapist about exercises appropriate for you condition.

Listen to your body. If one persists on exercising in spite of the stinging pain, you will cause more damage to the rotator cuff. Basic rotator cuff rehabilitation involves stretching and is usually devoid of weight lifting exercises, at least in the beginning. But prior to actually performing the exercise routine, consult your doctor and physiotherapist first. Furthermore, if the injuries do not improve after a few months of non-surgical treatments, visit your physician and ask that some examinations be done like x-ray or other imaging devices.

Rotator Cuff Physical Therapy Strengthening Program

The key feature of the rotator cuff physical therapy and strengthening program is to prevent and alleviate the pain and recurrence that will worsen the condition. Some of the physical therapy involve is stretching exercises. A rotator cuff strengthening program is essential to maintain fluidity in movement around the joints.

Pain, weakness and hampered mobility are the most frequent symptoms of rotator cuff tear. The pain tends to increase when a patient tries to raise their arms over-head. Night pain is always a complaint among those who suffer from a torn rotator cuff. Especially when trying to sleep on the affected shoulder. Luckily, all of this can be addressed with the proper rotator cuff physical therapy and strengthening program.

Range of Motion Exercises (ROM)

Injuries produce scar tissues and soft-tissues tend to contract, this is why a patient suffering from torn rotator cuff experience stiffness in the shoulders. By knowing how to properly stretch, a patient can perform everyday activities without feeling stiff. ROM or range of motion exercises should be done twice a day to keep the shoulders from being stiff. It is done through carefully moving the joint as far as it can go in all directions. This is also called pendulum exercise.

Once the pain is resolved, exercises to strengthen the rotator cuff muscles are important to maintain normal shoulder function and prevent future injury. The goal is to strengthen the muscle and tendons around the shoulder and increase endurance and improve the range of movements. Some of the other exercises that are ideal are shoulder shrugs, rowing and lifting weights that are two to four kilograms only and using thera-bands to increase resistance and strength.

These exercises can help reverse muscle weakness which is due to inflammation and will enable the tendons to bounce back to its normal ability. The best advice is to avoid exercises that will let you raise your arm over the head.

Rotator cuff physical therapy and strengthening program has other types of therapy, which a trained health practitioner can prescribe to aid you in faster recovery. There are machine that caters to this kind of condition such electrogalvanic stimulation, ultrasound, transverse friction massages, and soft tissue mobilization to treat scar tissue in the rotator cuff.

A word of caution, although rotator cuff physical therapy and strengthening programs are aids to a faster recovery it is important that each exercises are done properly to avoid further complications.

Rotator Cuff Weight Exercises

So you want to do some rotator cuff weight exercises? Okay, before we get into rotator cuff exercises, lets have a look at what rotator cuff injuries are. Pain + swelling in the shoulder area = rotator cuff tear. Initially, the sharp pain occurs when one raises his arm over his head and, with much force, bring it down on his side. However, as the tear develops, little arm movements will cause excruciating pain, especially if treatment or therapy was not resorted to.

Rotator cuff injuries are not only isolated to athletic individuals, degeneration through aging produces such injuries as well. Accident is also an ever-present source of muscle pains and tendon tears. The activities we do can easily contribute to gradual wear and tear which can lead to shoulder injuries. From body builders to tennis players, and every individual, athletic or otherwise, so long as they put much stress on their shoulders, they are prone to rotator cuff injuries.

Anyway, prevention is better than cure, right? So we must do everything and anything to avoid an injury from happening. A lot of people are prone to suffer shoulder pains because they opt to forego the basics. An example would be stretching which is a simple exercise that seems to be present in every warm up of almost any sport. Still there are those who think that stretching is but a waste of time. Truly, stretching is one of the under utilized techniques for preventing injury, for enhancing ones performance, and for treating shoulder pains and tendon injuries.

Rotator cuff weight exercises can definitely strengthen the muscle area. But remember not to over do it. You might end up causing more damage. With that said, here are a few exercises.

On a flat surface like a table, bench or bed, lie on your stomach. And at a 90-degree angle, bend your elbow and put your arm out until it's at the same level as your shoulder. While holding a Light barbell, try to lift your arm at shoulder level. Hold for approximately 3 to 5 seconds then slowly lower the same. Repeat this exercise until your arms feel tired.

Another exercise is to lie on your side with one arm slightly flexed at the elbow and touching your stomach. With the weights, try to raise your arm towards the ceiling then little by little lower your arm placing it back to its initial position (stomach).

One more variation demands that the person sit upright, flex one arm in a 90 degree angle with the forearm resting parallel on the hand held weight. Gradually raise your arm until it demonstrates the oath taking position.

Remember, when using weights, note the capacity of your muscles. If your body allows you to lift a couple more pounds, then by all means add a little more. But again, do not go beyond your physical limits. Rotator cuff treatment can be done with or without surgery. It will all depend on the extent of the damage and the capacity of the patient (or if he's a good surgical candidate or not).

Pain is one of the symptoms of having a rotator cuff injury. Other indications include diminished range of shoulder movements, shoulder weakness, and inclination to maintain your shoulder in a stationary position.

The treatment for these injuries may dictate that surgery be performed. However, wouldn't it be easier for a person to prevent the injury from happening rather than to treat it and suffer from pain and immobility?