What Is a Torn Rotator Cuff?
One or more rotator cuff tendons may become inflamed from overuse, aging, a fall on an outstretched hand, or a collision. Sports requiring repeated overhead arm motion or occupations requiring heavy lifting also place a strain on rotator cuff tendons and muscles. Normally, tendons are strong, but the wearing down process may lead to a tear.
Signs of a Torn Rotator Cuff
Typically, a person with a rotator cuff injury feels pain over the deltoid muscle at the top and outer side of the shoulder, especially when the arm is raised or extended out from the side of the body. Motions like those involved in getting dressed can be painful. The shoulder may feel weak, especially when trying to lift the arm into a horizontal position. A person may also feel or hear a click or pop when the shoulder is moved.
Diagnosing a Torn Rotator Cuff
Pain or weakness on outward or inward rotation of the arm may indicate a tear in a rotator cuff tendon. The patient also feels pain when lowering the arm to the side after the shoulder is moved backward and the arm is raised.
- A doctor may detect weakness but may not be able to determine from a physical examination where the tear is located.
- X-rays, if taken, may appear normal.
- An MRI can help detect a full tendon tear, but does not detect partial tears.
If the pain disappears after the doctor injects a small amount of anesthetic into the area, impingement is likely to be present. If there is no response to treatment, the doctor may use an arthrogram, rather than an MRI, to inspect the injured area and confirm the diagnosis.
Treatment of Torn Rotator Cuff
Doctors usually recommend that patients with a rotator cuff injury rest their shoulder, apply heat or cold to the sore area, and take medicine to relieve pain and inflammation. Other treatments might be added, such as:
- electrical stimulation of muscles and nerves
- ultrasound therapy
- cortisone injection near the inflamed area of the rotator cuff
The patient may need to wear a sling for a few days. If surgery is not an immediate consideration, exercises are added to the treatment program to build flexibility and strength and restore the shoulder's function. If there is no improvement with these conservative treatments and functional impairment persists, the doctor may perform arthroscopic or open surgical repair of the torn rotator cuff.
What Is a Frozen Shoulder?
As the name implies, movement of the shoulder is severely restricted in people with a "frozen shoulder." This condition, which doctors call adhesive capsulitis, is frequently caused by injury that leads to lack of use due to pain.
Rheumatic disease progression and recent shoulder surgery can also cause frozen shoulder. Intermittent periods of use may cause inflammation. Adhesions (abnormal bands of tissue) grow between the joint surfaces, restricting motion. There is also a lack of synovial fluid, which normally lubricates the gap between the arm bone and socket to help the shoulder joint move. It is this restricted space between the capsule and ball of the humerus that distinguishes adhesive capsulitis from a less complicated painful, stiff shoulder. People at a higher risk for frozen shoulder include those with certain conditions including:
The condition rarely appears in people under 40 years old.
Signs of Frozen Shoulder
With a frozen shoulder, the joint becomes so tight and stiff that it is nearly impossible to carry out simple movements, such as raising the arm. People complain that the stiffness and discomfort worsen at night. A doctor may suspect the patient has a frozen shoulder if a physical examination reveals limited shoulder movement. An arthrogram may confirm the diagnosis.
Treatment of Frozen Shoulder
Treatment of frozen shoulder focuses on restoring joint movement and reducing shoulder pain. Usually, treatment begins with nonsteroidal anti-inflammatory drugs and the application of heat, followed by gentle stretching exercises. These stretching exercises, which may be performed in the home with the help of a therapist, are the treatment of choice.
In some cases, transcutaneous electrical nerve stimulation (TENS) with a small battery-operated unit may be used to reduce pain by blocking nerve impulses. If these measures are unsuccessful, the doctor may recommend manipulation of the shoulder under general anesthesia. Surgery to cut the adhesions is only necessary in some cases.