ROTATOR CUFF SYNDROME: SYMPTOMS, DIAGNOSIS, AND TREATMENT

Rotator Cuff Syndrome includes a wide range of conditions and injuries affecting your shoulder muscles. It is a common condition most often caused by wear and tear from daily use.

The rotator cuff is a group of muscles covering your shoulder joint and attaching to your shoulder blade. It comprises four muscles and their tendons; the Supraspinatus, Infraspinatus, Teres minor, and Subscapularis (SITS).

The rotator cuff tendons and muscles stabilize your shoulder and allow a full range of movement and flexibility.

Your chances of developing rotator cuff syndrome increase with age. In fact, it occurs in 60% of people over the age of 80 years because of the decline and deterioration of the SITS muscles.

Early diagnosis of rotator cuff syndrome is vital to determine the role of treatment. Most people with rotator cuff syndrome can manage their pain and bounce back with physical therapy. Extensive rotator cuff diseases aren’t as easy to deal with and might require surgical intervention.

What is Rotator Cuff Syndrome?

Your shoulders are constantly in motion every day when you’re reaching for something on a top shelf, engaging in sport, or simply stretching. It’s a simple process that we often take advantage of. A complex interplay of muscles and tendons controls our shoulder function.

Rotator Cuff Syndrome (RCS) is any injury, disease, or degenerative condition that affects the rotator cuff muscles and tendons of your shoulder. These muscles and tendons are vulnerable to damage because of repetitive use, and when this happens, your shoulder functions poorly.

To help understand better, let’s take a look at a few conditions associated with rotator cuff syndrome:

• Rotator Cuff Tendonitis: This is an acute or chronic condition affecting the tendons of your rotator cuff. Your tendons become irritated and inflamed because of repetitive force or overuse.
• Subacromial Bursitis: Your shoulder has a bursa (a soft tissue sac) in between your bone and rotator cuff. It provides lubrication for your tendons to glide smoothly when you move your arm. This bursa can become inflamed and accumulate more fluid, causing pain that worsens with continuous use of your arm.
• Subacromial Impingement Syndrome: As your tendons move over the bursa, they can rub and become inflamed themselves. It results in shoulder weakness, pain, and diminished range of motion.
• Rotator Cuff Tears: This occurs when the tendons of your rotator cuff SITS muscles are torn. We can classify these tears as Partial-thickness (PTT) or Full-thickness Tears (FTT). Shoulder tears can arise because of micro traumas, severe trauma, or degenerative changes in your rotator cuff.

Rotator cuff syndrome may even develop because of a single injury. The pain in your shoulder can start as a dull ache that worsens over time and with continual use of your arm.

What Are The Symptoms Of Rotator Cuff Syndrome?

Rotator cuff syndrome generally results in swelling and tenderness that can severely limit your movement. The early stages of RCS can show mild symptoms like sudden shoulder pain. But as your condition progresses, you may experience a significant loss of strength and difficulty lifting your arm.

Each specific rotator cuff condition typically presents its own signs and symptoms. But, if you have shoulder cuff syndrome, you can expect:

• Numbness
• Tenderness
• Shoulder pain or soreness around your shoulder area
• Swelling at the side of your arm or in front of your shoulder
• Weakness in your arm
• Limited mobility in the affected arm, especially with arm lifting
• Interruption of sleep because of shoulder pain
• Difficulty in carrying out tasks that require overhead motions, such as brushing your hair or throwing a ball

When Do I Need To See A Doctor?

You will know it's time to seek medical care when:

• You experience one or more of the stated symptoms
• You experience severe pain after an accident, such as falling on your arm
• The symptoms persist or become worse

Experiencing slight discomfort after sleeping in an awkward position or lifting a heavy object may not indicate rotator cuff syndrome. If your symptoms progress, seek professional medical advice to treat them as soon as possible. Rotator cuff syndrome is usually treated and managed by an orthopedist or orthopedic surgeon.

What Causes Rotator Cuff Syndrome?

The causes of rotator cuff syndrome largely stem from injury to the shoulder and progressive degeneration or wear and tear of the tendons. We can broadly classify these causes into two groups: Extrinsic Compression Factors and Intrinsic Degenerative Factors.

Extrinsic Compression Factors

Imagine you’re watching a baseball game, precisely when the pitcher throws the ball. The pitcher’s arm forms an L-shape towards their back. They position their arm away from their body and rotated outward. The pitcher does this many times in one game alone.

External factors like repetitive stress, and too much load on your muscles, can lead to impingement. Impingement simply means "more than the usual contact.” This occurs when your injured tendons become swollen and rub against the bony surface of your shoulder joint more than usual.

1. External Impingement: This is often known as Subacromial Impingement because it occurs in your subacromial space (a space in your shoulder joint). The soft tissues (tendons, ligaments, muscles) of your rotator cuff are entrapped in the narrow subacromial space, leading them to be pinched.
2. Internal Impingement: Internal impingement occurs when there is an excessive contact of the shoulder socket with the head of the upper arm bone.

Most likely, a baseball pitcher has a big chance of developing rotator cuff syndrome. Other activities that promote impingement include:

• Swimming
• Baseball
• Tennis
• Volleyball
• Painting
• Window washing
• Weightlifting
• Rock climbing
• Swinging a hammer

Intrinsic Degeneration

Intrinsic degeneration, on the other hand, refers to the weakening of your rotator cuff. There is a gradual decline in the strength and overall stability of your rotator cuff. Several intrinsic mechanisms contribute to the weakness of your shoulder muscles over time:

• Vascular changes around your tendons
• Genetic variations
• Mechanical properties of your tendons
• Anatomical structure of your tendons

More often than not, these intrinsic mechanisms are related to the degeneration you experience with age. Studies show that rotator cuff syndrome is less prominent in patients less than 40 years and increases progressively in patients over 50 years.

Risk Factors of Rotator Cuff Syndrome

Rotator cuff syndrome stems from repetitive activity and overhead movement for a prolonged period. Certain factors can promote these activities or put you at a greater risk for rotator cuff syndrome:

• Age - Rotator cuff injuries are most common in people over 60
• Family history - Rotator cuff injuries are apparent in certain families. It may involve a genetic component that allows rotator cuff syndrome to be passed down.
• Occupation - Rotator cuff syndrome is prevalent among construction jobs. The repetitive, often overhead motions like painting and carpentry can damage your rotator cuff.
• Athletes - Baseball players, basketball players, javelin throwers, and other athletes often experience rotator cuff injuries because of the constant stress on their rotator cuff muscles and tendons.
• Weightlifting - Overhead lifting and pressure from the weights can increase the chances of weightlifters developing rotator cuff syndrome. Shoulder pain when using dumbbells and lifting weights in shoulder and chest exercises is typical of rotator cuff syndrome.

Complications Of Rotator Cuff Syndrome

An untreated rotator cuff problem can lead to your condition becoming worse and may lead to progressive deterioration of your shoulder joint. Diagnose and treat your rotator cuff syndrome before it results in severe complications, such as:

• Adhesive capsulitis (an inflammation of your shoulder joint capsule)
• Degeneration of rotator cuff muscles
• Altered function of the shoulder joint
• Constant pain
• Reflex sympathetic dystrophy (burning shoulder pains as a result of nerve injury)

How Is Rotator Cuff Syndrome Diagnosed?

Diagnosing a rotator cuff injury starts with a comprehensive review of your medical history and any sporting or daily activities that you had engaged in. Further investigation into your condition may include a series of physical examinations to assess the function of your rotator cuff:

1. Neck Exam: Your doctor will need to use a combination of tests that evaluate your muscle alignment, neck posture, and presence of tenderness. They may also use mild electrical stimulation to check the strength and reflexes of the muscles in your rotator cuff.
2. Shoulder Exam: Your doctor will physically examine your shoulder’s range of motion, muscle strength and mass, and stability by moving and manipulating your arm. They will also need to look at your shoulder for evidence of surgery and possible injury from the procedure.

If your orthopedist observes the following signs, your condition is most likely rotator cuff syndrome:

• You are unable to keep your arm outstretched to the side
• If you feel pain when your arm is lifted and moved forward more than 90 degrees
• You find it difficult to rotate your arm outward

What Are The Treatments For Rotator Cuff Syndrome?

Your treatment options for rotator cuff syndrome are based on your symptoms and the severity of your condition. If your case of RCS is not severe or shows mild symptoms, you can consider conservative treatment to help you manage your pain.

Rest

Sometimes, all you can do to treat pain is to simply rest. Most of the time, rotator cuff syndrome progresses because of continual activity. Avoid movement that can further stress your shoulder joint.

Most of the time, these activities involve overhead motions. So, take time off from swimming, sports, and lifting weights. Keep your weight off of your affected shoulder when you sleep by lying on your other side. Ice packs are also a quick fix to relieve inflammation and sudden pain caused by shoulder impingement.

Physical Therapy

Your orthopedist may recommend you to a physical therapist to treat rotator cuff problems. Physical therapy often involves a specific treatment plan to improve your stability, strength, and range of motion.

Some of these motion exercises are stretching exercises, isometric muscle toning exercises, and weighted pendulum exercises.

Medication

Drugs such as non-steroidal anti-inflammatory drugs (NSAID) can reduce the pain and inflammation caused by your rotator cuff syndrome. Your doctor will most likely prescribe the medication based on the extent of your pain.

Corticosteroid injections

Intra-articular steroid injections are a common non-surgical way to treat rotator cuff syndrome. Your orthopedist injects steroids into the joint, usually with the help of ultrasound imaging. The corticosteroids reduce inflammation and can many times cure rotator cuff without surgery.

Surgery

Most of the time, surgical treatments are the last resort for treating rotator cuff injuries. Your doctor may suggest surgery for more extensive cases of rotator cuff syndrome. There are several rotator cuff surgical procedures:

• Arthroscopic Surgery: Your surgeon may need to repair damaged tissues in your shoulder joint. They do this by inserting a scope into your shoulder that will guide them in removing the damaged bones and soft tissue.
• Acromioplasty: If your rotator cuff syndrome is caused by constant contact and friction, your surgeon may shave off a part of the bone called the acromion. The acromion is the outer edge of your shoulder blade and aids in stabilizing your shoulder joint.
• Tendon Transfer: Rotator cuff syndrome caused by torn tendons may be too severe. For tendons that are severely damaged and can no longer be reattached, your surgeon can decide to use a nearby tendon to replace the torn one.
• Shoulder Replacement: Shoulder arthroplasty is a surgical technique that replaces your whole shoulder joint because of a rotator cuff injury. Your surgeon can implant an artificial joint (prosthesis) in its place. They install one part of the artificial joint onto the shoulder blade and the other part into the socket of the arm bone.

Outlook Of Rotator Cuff Syndrome

Every rotator cuff treatment aims to relieve the symptoms and improve the condition of your shoulder. For both surgical and non-surgical treatments of rotator cuff syndrome, recovery may be a slow process. But with consistent treatment sessions and aftercare, pain from rotator cuff syndrome can be significantly relieved, and you can slowly restore the full function of your shoulder.

Frequently Asked Questions (FAQ)

Does rotator cuff syndrome go away alone?

Rotator cuff syndrome can resolve alone without treatment in mild cases, or when the causative factor stops (e.g. taking a rest from sports). In more severe cases, the symptoms may persist. The severity of the symptoms and the method of treatment will determine how long your condition will last.

What happens if you don't fix a torn rotator cuff?

Leaving a torn rotator cuff untreated will lead to complications that further deteriorate your shoulder function. This includes a limited range of motion, weakness, and loss of shoulder muscle bulk.

Is rotator cuff syndrome serious?

Your doctor should carry out a proper diagnosis to determine the severity of the condition. Most times, non-operative methods are enough to treat the disease, but more severe cases require surgery. All in all, rotator cuff syndrome is not a dangerous condition, however, it can adversely affect your joint function.

Is ice or heat better for a torn rotator cuff?

Ice is better at the onset of injury as it helps to reduce swelling and relieve pain. Heat is preferable down the line, as it promotes healing by increasing blood flow.

Will push-ups hurt my rotator cuff?

Activities that strain your rotator cuff will cause shoulder pain. It's best to avoid push-ups and other vigorous activities such as heavy lifting and sports until your shoulder has fully recovered.

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Sources

• Rotator Cuff Syndrome
• Shoulder Conditions: Rotator Cuff Injuries and Bursitis
• Rotator Cuff problems
• Rotator Cuff Tears, Injuries, and Treatments
• Repetitive Motion & Overhead Injury
• Rotator Cuff Tendinitis, Shoulder Bursitis, Impingement Syndrome
• Shoulder Impingement Syndrome
• What are the complications of rotator cuff injuries when treatment is delayed?
• What are the complications of untreated shoulder impingement syndrome?
• Rotator cuff injury
• What to do about rotator cuff tendinitis
• Surgical management of the symptomatic os acromiale

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