Katie Rice Dr. Glumac Computer Library Project November 16, 2007 Cause and Treatment of Rotator Cuff Injuries Following in close pursuit to the heavily treated musculoskeletal disorders of low back and neck pain, shoulder injuries have become extremely prevalent within society and have placed a significant impact on health care and treatment facilities. Rotator cuff diseases constitute a large majority of shoulder injuries. As these injuries are linked with age and a growing population of elderly individuals, rotator cuff issues will only continue to further increase in their impact on health care (1). It is vitally important to recognize the onset of rotator cuff injuries and to subsequently develop an effective treatment program. The shoulder is regarded as the most flexible and mobile joint in the human body. It is a ball-and-socket joint structure that allows for a tremendous range of motion. However, this wide range of motion also places the shoulder at an extremely high potential for injury. Four distinct muscles are involved in stabilizing the shoulder and reducing the risk of injury. This group of muscles is comprised of the subscapularis, the supraspinatus, the infraspinatus, and the teres minor. Functioning together, these muscles secure the head of the humerus in the glenoid cavity and allow the deltoid to raise the arm. The supraspinatus tendon is the most commonly injured tendon in a rotator cuff tear (2). Injuries to the rotator cuff can be categorized as either impingements or tears. An impingement results when the space between the acromion process and the rotator cuff narrows and causes the tendons to become pinched. The narrowing of the space often occurs due to the
process of aging (2). It can also be triggered when a person sustains a traumatic injury to the shoulder or repetitively over-stresses the shoulder joint. Baseball, swimming, and tennis are typical sports that often place excessive stress on the rotator cuff (3). Chronic impingement of the rotator cuff tendons will eventually lead to a partial or complete tear of the rotator cuff (2). Interestingly, a recent study has shown that smoking increases a person’s risk in developing rotator cuff tears. The study concluded that “patients who had regularly smoked within ten years of the development of shoulder pain were 4.74 times more likely to have a rotator cuff tear compared to someone who did not smoke at all” (1). Due to the trauma that is inflicted upon the shoulder during impingement, many problems arise, such as inflammation, swelling, pain, and reduced function (4). Patients dealing with rotator cuff injuries usually experience pain with overhead activity, abduction, and internal rotation (placing the arm behind the back). An overall weakness in strength will be noted by doctors and therapists when resistance is applied to any position of an extended arm that is suffering from a rotator cuff tear. In addition to these symptoms, rotator cuff tears typically cause discomfort at night and frequently interrupt a person’s cycle of sleep (1). When determining the proper treatment program to utilize for repairing the rotator cuff, a patient may either choose to undergo surgery or become involved in a non-operative program. Recent trends have shown an inclination toward surgery, although a considerable number of patients still choose to make use of conservative non-operative treatment (5). Non-operative treatment includes anti-inflammatory drugs, corticosteroid injections, and physical therapy. When utilizing this treatment program, the initial desired goals are reduced inflammation and increased range of motion. In regard to the overall effectiveness of non-operative treatment, results are extremely variable. Successful results have been shown to range from 25% to 82%.
Certain factors have been identified to predict a negative outcome with non-operative treatment. These factors include “large tears, limited range of motion, and a long duration of symptoms and severe rotator cuff weakness”. If a patient chooses an operative treatment program, results have also shown to be highly variable. Rotator cuff surgery is usually recommended by doctors when insignificant improvements in shoulder function or pain reduction have been noted after a series of non-operative therapies. The surgery can either be performed with the open procedure or the less invasive option of arthroscopy. After a patient has received surgery, the arm will be placed in a sling. Shoulder movements should also be monitored closely during the first three months post-surgery. Passive range of motion exercises performed by a physical therapist are extremely beneficial to the patient and should be utilized as soon as possible to reduce the risk of scar tissue formation and stiffness. Within six weeks after the surgery, a patient will be introduced to more advanced methods to assist in strengthening the rotator cuff and shoulder muscles. Full recovery from rotator cuff surgery is typically one year (1).
Works Cited 1. Baumgarten KM. Current concepts in the treatment of full-thickness rotator cuff tears. South Dakota journal of medicine. 2007; 60: 303-311. 2. Marks BL. Rotator Cuff Surgery. In: Dawson DP, ed-in-chief; Tracy IG, Project Editor. Magill’s Medical Guide. Vol 4. 3rd revised ed. Pasadena, California: Salem Press, Incorporated; 2005: 2248-2249. 3. McMahon PJ. Current Diagnosis and Treatment: Sports Medicine. New York: McGraw-Hill Companies, Incorporated; 2007. 4. Manske RC. Postsurgical Sports Rehabilitation: Knee and Shoulder. St. Louis: Mosby, Incorporated; 2006. 5. Hawkins RH, Dunlop R. Nonoperative Treatment of Rotator Cuff Tears. Clinical orthopaedics and related research. 1995; 321: 178-188.