By Gilda Morales, ANP, DC
Today’s column deals with a common injury, rotator cuff tears, a condition that affects more than 2 million people in the United States alone every year. To understand the condition, one must understand the anatomy of the shoulder, which consists of three bones, the upper arm bone, or humerus, the shoulder blade, or scapula, and the collarbone, or clavicle. The joint is a ball and socket joint, with the ball or head of the humerus, fitting into the socket in the shoulder blade. The rotator cuff consists of four muscles that keep the arm in the socket and come together at the head of the humerus. Theses muscles are responsible for every movement that you make with your shoulder.
There are two main causes of rotator cuff tears—gradual tears caused by degeneration, and acute tears caused by trauma. Degenerative tears are usually the result of years of wearing of the tendons, usually in the dominant shoulder, from repetitive use such as throwing a baseball, tennis, rowing, weightlifting, or overhead lifting. These activities can cause partial tears that may eventually become full-thickness tears.
Acute tears are usually caused by lifting something too heavy, using a jerking motion when lifting and more commonly, falling down on an outstretched arm. There is usually intense pain and weakness and there may be a “pop” when falling.
It is also very common to have a rotator cuff tear with a broken collarbone or dislocated shoulder. The main symptoms of a rotator cuff tear include
•Pain at rest and at night, especially if lying on the affected shoulder
•Pain when lifting and lowering the arm with specific movements
•Weakness with lifting or rotating the arm
•Creaking or crackling sensation when moving the shoulder in certain positions.
Rotator cuff tears require an MRI to make a definitive diagnosis—plain x-rays will not show soft-tissue injuries. Treatment should first attempt to relieve the symptoms with the use of medication and physical therapy after resting the shoulder and avoiding movements that aggravate the pain. However, there are some disadvantages of non-surgical treatment in that there will be no improvement in strength, the tear may get larger and activities may have to be modified to prevent pain.
