Rotator Cuff Injuries

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Introduction

Rotator cuff injuries refer to injuries to the rotator cuff which is a group of muscles and their tendons that act to stabilize the shoulder. The muscles and tendons of rotator cuff surround the shoulder joint, keeping the head of upper arm bone firmly within the shallow socket of the shoulder. A rotator cuff injury can cause a dull ache in the shoulder, which often worsens while sleeping on the involved side.

Rotator Cuff Injuries

Causes

Rotator cuff injuries may be associated with a specific injury such as a fall, or it gradually deteriorates over time and is increased by activity of the muscle, nerves or joints. The shoulder joint is a ball and socket type joint where the top part of the arm bone forms a joint with the shoulder blade. The rotator cuff holds the head of the arm bone into the scapula and controls movement of the shoulder joint. The tendons of the rotator cuff pass under a bony area on their way to attaching the top part of the arm bone. When these tendons become inflamed, they become more frayed over this area during shoulder movements. Sometimes, a bone spur may narrow the space even more. This problem is called rotator cuff tendinitis, or impingement syndrome, and may be due to:

  • Keeping the arm in the same position for long periods of time, such as doing computer work or hairstyling
  • Sleeping on the same arm each night
  • Playing sports requiring the arm to be moved over the head repeatedly as in tennis, baseball (particularly pitching), swimming, and lifting weights over the head
  • Working with the arm overhead for many hours or days (such as in painting and carpentry)
  • Poor control or coordination of your shoulder and shoulder blade muscles
  • Poor posture over many

Rotator cuff tears may occur in the following ways:

  • A sudden or acute tear may happen when you fall on your arm while it is stretched out, or after a sudden, jerking motion when you try to lift something heavy.
  • A chronic tear of the rotator cuff tendon occurs slowly over time. It is more likely in those with chronic tendinitis or impingement syndrome. At some point, the tendon wears down and tears.

Signs and Symptoms

Tendinitis or Impingement Syndrome

In early stages of disease, pain occurs with overhead activities and lifting your arm to the side including activities like brushing hair, reaching for objects on shelves, or playing an overhead sport. Pain mostly occurs in the front of the shoulder and may radiate to the side of the arm. However, the pain of tendinitis or impingement syndrome always ends before the elbow. There may be pain with lowering the shoulder from a raised position. On early, this pain may be mild and occur only with certain movements of the arm. Later on, the pain may be present at rest or at night, especially while lying on the affected shoulder.

There may be weakness and loss of motion while raising the arm above your head, stiffness of the shoulder with lifting or movement. It may become more difficult to place the arm behind the back.

Rotator Cuff Tears

The pain with a sudden tear after a fall or injury is usually extreme. Weakness of the shoulder and arm may also present, along with a snapping sensation of movement.

Chronic rotator cuff tear includes a gradual worsening of pain, weakness, and stiffness or loss of motion. Most people with rotator cuff tears have pain at night. Pain that is worse at night may disturb your sleep. During the day, the pain is more tolerable and hurts more only with certain movements.

Over time, the symptoms if not addressed properly become much worse and intolerable.

Symptoms of Rotator Cuff Injuries

KKT Diagnosis

KKT diagnosis of rotator cuff injuries starts with history, physical examination and 3D spine X rays. Physical examination may reveal tenderness over the shoulder and pain may occur when the shoulder is raised overhead. There is typically weakness of the shoulder when it is placed in certain positions. If your Canadian Certified KKT Orthopedic Surgeon feels you have a rotator cuff tear, he may ask you to have one or more of the following tests:

  • An ultrasound test to create an image of the shoulder joint showing a tear in the rotator cuff.
  • Magnetic Resonance Imaging (MRI) of the shoulder may show swelling or a tear in the rotator cuff.
  • Computed tomography (CT) shows tear of the rotator cuff but not as effective as MRI.
  • Plain films (X-rays) don’t show rotator cuff problems, but show fractures, bone spurs, or other bone abnormalities.
  • Sometimes, a special imaging test called arthrography is needed to diagnose a rotator cuff tear. Your Canadian Certified KKT Orthopedic Surgeon will inject contrast material into shoulder joint. Then an x-ray, CT scan, or MRI scan is used to take a picture of it.

KKT Treatment

Clinically relevant factors to keep in mind with the treatment of the shoulder, is that treatment not only requires rest, but also requires that the neck and its nerve supply be restored. The KKT treatment plays an integral role in restoring the neck nerve supply by repositioning the spinal vertebras back to their normal symmetrical position thus reducing the rotator cuff injuries pain. KKT process plays a fundamental role in stimulating the connective tissues of the spine to escalate cellular regeneration. It also emphasizes on life style modifications including postures and sleeping positions modifications.

KKT treatment along with individualized exercise program and life style modifications, the rotator cuff can be strengthened, shoulder injuries can be rehabilitated and future occurrence can be prevented.

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Dr. Geoff Desmoulin, PhD

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