Rotator Cuff Injury

The rotator cuff is a group of muscles which work together to provide the stability to shoulder joint, helping to control thejoint during rotation (hence the name).

The rotator cuff muscles include 4 main muscles.

Supraspinatus
Supraspinatus
Infraspinatus
Teres Minor
Subscapularis

Due to the function of these muscles, sports which involve a lot of shoulder rotation – for example, bowling in cricket, pitching in baseball, swimming, javelin throw,basketball,volleyball – often put the rotator cuff muscles under a lot of stress.

Problems with the rotator cuff muscles can be classed into two categories – Tears of the tendons/muscles, and inflammation of structures in the joint.

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Acute Tear

Shoulder will be helped by:

Rest the shoulder
Ice can be used at least 3 times a day and is useful for the first couple of days following an injury
Hot may be useful after the first few days to help with the pain
NSAIDS helpful to help control the pain – speak to your doctor

Treatment for an Acute Rotator Cuff Tear

Apply ice to reduce swelling as above
Control the pain with appropriate medications
Rest the arm – a sling can sometimes be quite useful if you still need to go to work/school, which can be removed at night
You may require imaging studies like MRI.
Consider consulting a shoulder specialist who can advise you with management of injury

If the injury is quite severe and you are young and active, you might require an operation to fix the tear. This needs to be done within 3-6 weeks. Indications include:

Complete tears of the tendon/muscle
Difficulty in lifting the arm.
Failure of other treatments after 6 weeks
Professional/keen sports people
If your job requires constant shoulder use

Subacromial Bursitis /R.C tendinitis/ Impingement syndrome

The supraspinatus muscle runs along the top of the shoulder blade and inserts via the tendon at the top of the arm (humerus bone). This muscle is used to lift the arm up sideways and is also important in throwing sports as it is the muscle that holds the arm in the shoulder when you release what you are throwing. There are massive forces involved in slowing the arm down after you have thrown something but few people bother to train these muscles. A heavy fall onto the shoulder can also result in injuring this muscle.

Over the tendon is a bursa (small sack of fluid used to help lubricate the moving tendon). This bursa can become trapped in the shoulder causing pain and inflammation.

The athlete is more prone to this injury if they overuse the shoulder particularly if the arm is at or above shoulder level. Or if the athlete has had a rupture of the supraspinatus tendon.

Symptoms include:

Pain and weakness when the arm is lifted up sideways through a 60 degree arc.(Painful one)
Pain when you press in at the inside front of the upper arm.
Manual therapy (mobilization and manipulation)
If it is the tendon that is injured rather than the bursa there is likely to be more pain when the arm is lifted up sideways against resistance.

What can the athlete do?

Rest until there is no pain.
They must however continue pain free mobility exercises to keep the full range of movement in the shoulder.
Apply Hot pack.
See a sports injury specialist or doctor who can advise on rehabilitation.

What can a sports injury specialist or doctor do?

Prescribe anti-inflammatory medication
Prescribe a full rehabilitation program.
Operate with persistent problems.
Local injection (PRP / Cortisone)