Monday Medical: Rotator cuff injuries
For Steamboat Pilot & Today
If it hurts when you reach out your arm, you just may have injured your rotator cuff, the group of four muscles surrounding the shoulder joint that keep the upper arm bone centered in its socket.
“The shoulder is like a golf ball sitting on a tee,” said Dr. Adam Wilson, an orthopedic surgeon in Steamboat Springs and a member of the medical staff at UCHealth Yampa Valley Medical Center. “The rotator cuff keeps the shoulder in proper position, which allows for the wide range of motion we have in the shoulder compared to other joints.”
That range of motion also makes the rotator cuff vulnerable to injury. Wilson outlines common injuries and treatments below.
Rotator cuff injuries can be caused by either overuse or trauma, which can happen in a fall or shoulder dislocation. Injuries also crop up as part of the aging process.
“As people get older, it’s pretty common to have tearing or tendonitis of the rotator cuff, and it may not be the result of a specific activity,” Wilson said.
Though a rotator cuff injury can affect anyone, people who do a lot of heavy, overhead lifting at work may be more prone to one.
An injured rotator cuff is usually painful and may cause a dull ache deep in the shoulder. The pain often strikes when reaching overhead or away from the body.
“Putting dishes away on a shelf is often difficult or painful,” Wilson said. “A lot of people with rotator cuff issues have pain at night, especially if they’re sleeping on the injured side.”
Weakness when lifting the arm may be a sign of a more serious rotator cuff injury.
First, the injury is assessed through an in-depth examination. If there are signs of weakness, an MRI may be ordered to determine if there is a serious tear.
Otherwise, first-line treatment is often over-the-counter or prescription anti-inflammatories, physical therapy and, sometimes, a steroid injection in the shoulder.
“When the area is in pain, small muscles often shut down and stop working properly. That creates a cycle of pain that’s hard to get rid of,” Wilson said. “A steroid injection can help with inflammation, so people feel less pain, and then (physical therapy) can get the muscles working better.”
This approach is usually tried for six to eight weeks. If there’s no improvement, an MRI may be ordered to determine whether further action would be helpful.
For serious injuries or persistent pain, a patient may consider a minimally invasive shoulder surgery. But, it’s used as a last resort.
“Not everyone with a rotator cuff tear needs shoulder surgery,” Wilson said. “With PT, other muscles can get stronger and function well, and some people can be pain free.”
In fact, about half of people older than 50 have some degree of a rotator cuff tear. Only half of those people with an injury have symptoms or pain.
“There are plenty of people who can compensate, and sometimes, it’s just about getting the pain under control and getting the muscles strong,” Wilson said. “If that fails, then we talk about doing a rotator cuff repair.”
After surgery, physical therapy is extremely important to a full recovery.
“The rehab side has evolved, and we’re a little more aggressive about getting people moving earlier,” Wilson said. “Like all shoulder surgery, the recovery’s not short — it takes four to six months. But if someone allows for appropriate healing and follows what their doctor and physical therapist say, it’s very successful.”
The best way to prevent a rotator cuff injury is to keep your shoulder muscles strong. But that doesn’t mean lifting heavy weights.
“It involves very light weights and focuses on certain strengthening movements so all four muscles are working appropriately,” Wilson said. “The stronger you can keep those muscles, the more they will protect the shoulder both in the short and long term.”
Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at email@example.com.
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A serious climbing accident, including a forceful twisting and smashing spiral fracture to her right ankle, put Joan Allison Weiss in pain and limited her mobility for almost 20 years.