There are four muscles that make up the rotator cuff, they are around the gleno humeral joint, their tendons join together around the top of the joint to provide a "cuff" that prevents the ball of the joint from coming out. A force that is stronger than the cuff will cause dislocation or damage to the cuff, in the form of a tear. This will create inflammation and pain, often leading to reduced range of movement due to pain. A sudden movement such as a throw, tennis serve, bad weight lifting technique or an awkward lift such as reaching behind to the back seat of the car to lift a bag are typical onsets. As a result it is often the dominant arm that is damaged.
The prognosis varies, but in all cases it is important to avoid the sharp intense pain from occurring. Typically if it is aggravated doing the wrong movement the patient will have 30 seconds of severe pain that rapidly reduces and the patient can continue as before. Learn from your experiences. Applying ice to the area is always a good idea, 5-10 minutes with a layer of material between your skin and the ice pack.
It is often possible to continue with other vigorous movements that do not involve that particular part of the tendon, i.e. golf is often possible.
There are other causes of acute and chronic gleno-humeral pain that can appear very similar to rotator cuff damage.
There are two main investigations that can be done to clarify the diagnosis. Ultra sound scanning is becoming more popular as the modern equipment is able to deliver clearer images, it is dynamic meaning that the joint can be moved while the scan takes place. This allows us to see how a tissue is effected by movement or contraction. It also allows any intervention such as an injection or drainage to be done under guidance improving the success rate significantly.
The alternative is an MRI scan. The advantages of this are that there is an image saved that can be looked at whenever required. There is no unnecessary radiation (neither is there in U/S). There are situations where it is not suitable, if the patient has a pacemaker or any other fine metal items in the body that have an important role such as clips in the eyes. Large items such as hip replacements interfere with the signal. If a patient is claustrophobic that will also be an issue, although there are some open scanners that help to get round this.
As Osteopaths we will establish the cause of the pain and then look at why this has occurred. There may be chronic musculoskeletal issues that predispose to the injury occurring. We will treat these and may prescribe exercises, often eccentric exercises to stress the tendon while it is stretched which has been shown to reorganise a damaged tendon at the cellular level.
So remember if you feel any twinge or ache around the shoulder joint, stop the activity, see if there is a different way of doing it without pain. If not stop allow a week to see if it recovers.
Technique is vital, timing comes with good technique, therefore more effective. Classic example is the Tennis serve. A badly timed serve with lots of effort is unlikely to be successful and highly likely to cause tendon damage.
As we get older the amount of elastin in our connective tissue becomes less, which contributes to the tissue becoming less able to stretch when taken to the end of its range.
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