Shoulder pain: understanding rotator cuff injuries
A person with a shoulder tendinitis or more specifically rotator cuff injury often experiences shoulder pain, especially at night, and shoulder weakness.
The group of rotated cuff muscles stabilise the shoulder joint dynamic movements. At the top of the arm, these muscles and their tendons blend together, creating a “cuff”. The rotator cuff is prone to injuries and can be acute or chronic. Acute shoulder injuries are muscle that result from traumatic events, such holding out the arm to break a fall.
Chronic shoulder injuries are injuries that result from overuse (fatigue) or entrapment (impingement) of the rotator cuff muscles and tendons. Athletes, swimmers, and construction workers are especially prone to chronic rotator cuff injuries. These chronic conditions are ongoing, with symptoms lasting 6 weeks or longer. Most rotator cuff injuries are treated with a combination of pain control, rest, and corrective rehabilitation. More severe injuries may respond better with shoulder injections and possibly surgery.
How do rotator cuff injuries occur?
The shoulder’s complexity allows for strength and dynamic mobility. This complexity also makes the shoulder prone to injury, and rotator cuff injuries are common. Rotator cuff injuries are typically attributed to trauma, degeneration, and shoulder impingement. Athletes that have a distinctive throwing motion puts them at a higher risk for rotator cuff problems. All four of these sources of injury are explained below.
1. An acute injury is caused from a traumatic event. A rotator cuff can be injured in a single trauma, such as trying to break a fall with an arm outstretched, lifting a heavy weight, or activities that place a tremendous amount of force or strain on the shoulder, such as holding a waterskiing tether. 2. Degenerative injury occurs over months or years As people age and/or overuse their shoulders over time, the rotator cuff go s through age relative degenerative changes, especially in people over 40 and those in occupations that require frequent raising and lowering of the arm, such as roofing or carpentry. Tiny tears develop in the rotator cuff muscles, making it weaker and more prone to larger tears. It is possible for these larger tears to occur without any notable trauma. 3. Shoulder impingement causes the rotator cuff to be pinched or trapped. Rotator cuff degeneration is sometimes associated with impingement. Shoulder impingement syndrome is an umbrella term that describes the painful entrapment of muscles, tendons or other soft tissue that is sandwiched in a space that is called the subacromial space. As the tendon become trapped or irritated they begin to thinken, making them more prone to tears. A bursa also lies in this spaces with the job of reducing friction. However, this can also become irritated with on going compression consequently causing bursitis (inflammation of the bursa). Causes of Shoulder impingement: Structural issues. The rotator cuff may be compressed when the space is inherently too small. This occurs with: Deformation of the bone, thickening of ligaments, degenerative changes of the acromioclavicular joint. Functional issues. While the rotator cuff muscles keep the shoulder joint stable, other muscles provide the shoulder with most of its power. As the rotator cuff fatigues, a person can have power without adequate stability. Stabilising muscle of the shoulder can fatigue or bad biomechanics (e.g. bad form during heavy lifting) can set into motion a series of events in the shoulder, as follows: Mal-tracking issues can occur. Mal-tracking refers to when a joint’s bones do not align normally or move against each other smoothly. This can l put more strain and pressure on the rotator cuff muscles. Strain and pressure on the muscles can cause pain as well as additional weakness and instability.
A rotator cuff injury can cause inflammation that leads to shoulder impingement or, conversely, shoulder impingement can lead to a rotator cuff injury. For example, bone spurs resulting from osteoarthritis.
What are the symptoms of rotator cuff injury?
The most common symptoms of rotator cuff injuries are stiffness, weakness, reduced mobility and increased shoulder pain. Shoulder pain
People with rotator cuff injuries complain about pain, especially at night. The shoulder may feel most stiff when getting out of bed in the morning.
Lifting the arm overhead or holding the arm away from the body may be difficult. The muscles at the back of the shoulder may appear smaller on the injured side than on the unaffected side.
Loss of range of motion. A person with an injured rotator cuff may not be able to move the arm through a normal range of motion. Swelling and tenderness. The front of the shoulder is often swollen and tender. Crepitus (shoulder popping and grinding). Cracking and popping sensations in the shoulder are also common, and may indicate the shoulder’s ball and socket joint is not tracking properly.
What are the causes of rotator cuff injury?
Rotator cuff injuries may be grouped into two major areas: traumatic injuries and degenerative injuries. While traumatic injuries are one-time events—often unforeseeable accidents—degeneration occurs over time. People with degenerative rotator cuff injuries tend to have one or more of the following risk factors: Overuse. Degenerative rotator cuff injuries are more common in people who engage in repetitive overhead shoulder motions, such as hammering, painting, swimming, playing tennis, or pitching a baseball.
Shoulder arthritis. People with shoulder arthritis are more likely to develop shoulder instability, muscle weakness, and bony cysts, called osteophytes. All of these factors can put more stress on the rotator cuff, making it more prone to injury.
Older age. Degenerative rotator cuff injuries tend to occur in people over 40 and become increasingly more common as people age. These injuries do not always cause symptoms and may not require treatment.
While older age is a risk factor, rotator cuff injuries are becoming more common in younger people as the emphasis on intense training and year-round sports for young people has increased.
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