Your rotator cuff is a group of muscles and tendons surrounding the shoulder. They help to provide stability and keep the head of your upper arm within your shoulder socket, as well as enabling your arm to rotate. Rotator cuff injuries are common in sports that involve making repeated overhead movements, as well as certain professions like carpentry or painting and decorating.
Symptoms of rotator cuff injuries
A torn rotator cuff causes a sudden and severe pain at the top and side of your shoulder if it the result of a single injury. Alternatively, microtearing may develop over time as the result of repetitive movements and this tends to cause a deep ache within your shoulder, sometimes accompanied by arm weakness. If you have a torn rotator cuff, it may be difficult to reach behind your back or comb your hair and the pain may worsen when you have your arm raised. Some people find it uncomfortable to sleep. The rotator cuff may become fully or partially torn.
Who is at risk?
Summer is a peak time for us to see people with rotator cuff injuries due to an increase in people playing sport. The rotator cuff is particularly prone to tearing in people over the age of 40 who play high impact sports. This is because the tendons degenerate naturally with age. A weakened rotator cuff may tear suddenly and completely in older sportsmen and women so it is important for people in this age group to warm up properly before a game and to train with a professional coach to ensure that they are using correct technique. A physiotherapist can recommend low resistance exercises to strengthen your rotator cuff, which is particularly important if you have had a previous injury.
Other factors that increase your risk of rotator cuff injury include having a job that necessitates making repetitive overhead arm movements and have a genetic predisposition.
High risk sports
Tennis players are one of the groups most at risk of rotator cuff injuries due to the strain placed on this group of muscles during the tennis serve. If you play tennis regularly you may develop microtears or partial tears in the rotator cuff due to the jarring caused by hitting the ball repeatedly. This is called tendinopathy and it can lead to subacromial bursitis, which causes pain in the upper arm which may be worse at night.
Golfers are also at risk of rotator cuff tears due to the strain placed on the shoulders, arms, back and wrists during the golf swing. Other sports that can cause rotator cuff tears include volleyball, basketball, swimming and weightlifting.
Diagnosis of rotator cuff injuries
A torn rotator cuff may cause degeneration of the shoulder joint if it is not treated so it is essential to get a proper diagnosis. Your doctor will carry out a physical examination and assess the strength of your shoulder and arm muscles. You may be sent for imaging tests such as an X-ray to rule out other causes of shoulder pain (for example, arthritis), or an ultrasound scan to assess the structures of your shoulder as you move. MRI scans are also sometimes used.
Treatment of rotator cuff injuries
Treatment for a rotator cuff injury depends on the severity of the tear. Your orthopaedic surgeon will always recommend conservative treatments first. If you suspect you may have a rotator cuff injury, rest the affected shoulder and use ice to bring down swelling. A physiotherapist may be able to recommend exercises to strengthen your shoulder and carefully restore flexibility.
If conservative treatments don’t alleviate the symptoms you may be offered:
- Injections of steroids into the affected shoulder joint.
- Tendon repair – This may be performed arthroscopically (using keyhole surgery) using a small incision and tiny instruments to reattach the torn tendons to the bone. However, some rotator cuff tears are more suitable for open surgery, using a larger incision to access the damaged tendons.
- Tendon transfer – If the tendons cannot be repaired it may be better to use a nearby tendon to replace the damaged one.
- Shoulder replacement – In very severe rotator cuff injuries, a shoulder replacement may be the only option. In some cases, a reverse shoulder arthroplasty (where the artificial joint has a socket on the arm bone and a ball on the shoulder blade rather than the other way around) may be the best way to ensure joint stability.
Pain in your shoulder that lasts beyond a few days needs to be investigated by a doctor to ensure that it is appropriately treated and to avoid the risk of long-term damage.
Castle Orthopaedics is here to help
Following the lockdown, Castle Orthopaedics is now re-open for virtual and face to face appointments at both Spire Nottingham Hospital and BMI The Park Hospital. Surgery is now also being scheduled once again, which means that injuries requiring surgery can be treated.
Our orthopaedic consultants each specialise in a particular area of orthopaedics, giving you added peace of mind that you are receiving expert medical advice and highly tailored treatment.
BMI The Park Hospital
Sherwood Lodge Drive Burntstump Country Park, Arnold NG5 8RX
Spire Nottingham Hospital
Tollerton Ln, Tollerton, Nottingham NG12 4GA