Rotator cuff injury causes shoulder pain in middle-aged and elderly people. It is difficult for people to raise their arms above their heads to do activities such as removing items from cabinets or closets, showering , or changing. In addition, the disorder is common in people who always keep their arms above their heads in daily activities, such as building painters or housewives (who are constantly picking up and putting things on the shelves above the cabinet) as well as athletes who have to keep their arms up while exercising, such as tennis, baseball, and badminton players.
The main cause of this disease is that a group of muscles called the rotator cuff (especially a muscle called the supraspinatus) are pressed between two bones in the shoulder area. The rotator cuff refers to four of the muscles that attach to the arm through the scapula. One of these four muscles, called the supraspinatus, passes through the upper arm bone and a scapular appendage called the acromion. Narrowing of this bony duct means that the muscle is pressed and damaged.
As a result of the pressure applied to these muscles between these bony canals, the area that bears the most pressure becomes inflamed. Over time, calcium deposits accumulate in these areas. As pressure and injury continue, the rotator cuff muscles wear and tear. This rupture is more common in the supraspinatus muscle and affects other rotator cuff muscles.
Causes of Rotator Cuff Syndrome and Impingement syndrome
Two groups of factors cause this disease. The most common type of disease usually occurs due to erosion of the structures around the shoulder. Distance between the acromion appendage and the humerus decreases, causing the rotator cuff muscles to become trapped and eventually rupture. Therefore, these injuries and lesions increase with age and over time, so most patients have had shoulder issues for more than forty years.
The less common type of lesion is a ruptured rotator cuff muscle due to injury from strenuous activity such as sports injuries. As a result, this type of disease is also seen in young and active people, such as athletes or workers who are very physically active.
Clinical Signs of Rotator cuff
Symptoms of rotator cuff disease depend on its extent, type, and location. Typically, early in the process, rotator cuff injury begins with constant pressure on the supraspinatus muscle, which causes inflammation in this muscle and surrounding soft tissue (called bursitis). As the inflammation continues right where the tendon in this muscle is most affected by the pressure, some calcium builds up in the tendon (tendonitis). Patients will complain of debilitating pain and weakness that may even wake them up at night. Since when a person lies on an injured shoulder while sleeping, he feels severe pain. This shoulder pain may also occur when changing clothes. In the more advanced stages of the disease, the rotator cuff fibres at the site of calcium deposition begin to disintegrate, which in this stage is called rotator cuff rupture. With a muscle tear, the pain gradually subsides, although it does not completely disappear. On the other hand, weakness of arm movements is exacerbated in some directions due to muscle tears.
Risk Factors Of Rotator Cuff
The following factors increase the risk of rotator cuff damage:
As you get older, it is more likely to get a rotator cuff injury. Rotator cuff rupture is most common in people over 40 years of age.
Athletes who have to move their arms frequently – such as baseball throwers, archers, and tennis players – are more likely to have rotator cuff injuries.
In occupations such as carpentry or painters, one has to move one’s arm frequently and often above the head. These movements over time may damage the rotator cuff.
This damage is more common in some families, so it seems that genetic components also play a role in causing this damage.
If left untreated, damage to the rotator cuff can lead to permanent loss of movement or weakness of the shoulder, eventually leading to the gradual destruction of the shoulder joint. Although resting the shoulders is essential for good health, keeping the shoulders steady for a long time may cause the surrounding connective tissue to thicken and shorten (frozen shoulder).
If you have had a rotator cuff injury in the past, doing daily stretching and strengthening exercises will prevent future injury. Most people strengthen the muscles in the front of the chest, shoulders, and arms, but to optimize the balance of the muscles in the shoulder area, strengthening the muscles behind the shoulders and around the shoulders is equally important. Your doctor or physiotherapist will help you plan a daily exercise program.
Rotator cuff treatment
Suppose you have any of these diseases involving the rotator cuff (bursitis, tendonitis, or incomplete ruptures), and you do not have enough education and information about this. In that case, you may intensify your injury and make the lesion worse. Treatment primarily involves resting and avoiding movements that aggravate shoulder pain, as these movements increase the pressure on the rotator cuff muscles and increase the risk of inflammation and rupture. Next, several anti-inflammatory drugs should be prescribed to reduce pain and treat local inflammation of the muscle tendons. While resting and avoiding certain movements increase the healing process, there are several specific exercises that increase the range of motion of the muscles and strengthen the shoulder muscles, which ultimately lead to the healing of these muscles. These exercises, along with the use of physiotherapy equipment, reduce pain. Despite these treatments, a group of patients will need to inject anti-inflammatory drugs into the position of the injured rotator cuff muscles. There are cases of shoulder muscle stiffness and rotator cuff syndrome that require surgery.
Types of Rotator Cuff Injuries
There are different types of rotator cuff injuries, depending on how severe the damage is to the tendons. They include:
Inflammation (tendinitis or bursitis)
is when the tendons or the fluid-filled sacs (bursae) that cushion the joint become irritated and swollen. This can cause pain and tenderness in the front or side of the shoulder, especially when raising the arm or lying on it.
This is when the tendon is frayed or damaged, but not completely severed. This can cause pain, weakness, and reduced range of motion in the shoulder.
This is when the tendon is split or detached from the bone. This can cause severe pain, weakness, and inability to lift or rotate the arm. Sometimes, a popping or snapping sound may be heard when the injury occurs.