The shoulder joint is the most mobile joint in the body, providing us with a tremendous range of movement where we can reach with our hands. The shoulder joint has this extra mobility because its design is different than most other joints in the body - the stability of the joint is provided by muscles and tendons rather than through the coupling of bones. There are four muscles surrounding the shoulder joint which provide this stability, collectively called the rotator cuff. You cannot feel these muscles by touching your shoulder - they are very deep in the shoulder tissue. Yet, every time you lift and rotate your arm, it is these four muscles which both move your shoulder and keep it located in its socket.
Problems with the rotator cuff are the cause of most shoulder pain in adults. People can develop tears in the rotator cuff muscles acutely as the result of a lifting, a sports injury, or trauma from a fall or accident. However, most frequently, people develop these problems slowly over time, especially those who do repetitive lifting or activities above the level of their shoulder such as painting, stocking shelves and construction. This pain may start as a small ache on the side of the shoulder during overhead or reaching motions, and may progress to pain at rest, even to the point of interrupting sleep. This shoulder pain can also be accompanied by stiffness, weakness and loss of range of motion.
Symptoms of shoulder pain should be evaluated by an orthopedic surgeon. Diagnosis of rotator cuff tear is based upon physical examination and often an MRI or ultrasound of the rotator cuff muscles. X-rays are not effective in diagnosis as they tend to be normal.
Most patients with early or mild symptoms will respond to non-surgical treatment, consisting of the combined approaches of activity modification, antiinflammatory medications such as ibuprofen, steroid injections and physical therapy. For these patients, recovery of strength and range of motion may take months to occur.
For patients with constant pain or weakness, or who fail to respond to treatment regimens, surgical repair of the rotator cuff muscles may be required. Depending upon the extent of the tear, surgery may be performed through small incisions with a camera arthroscopically, or through a traditional open incision. Many rotator cuff surgeries are now performed on an outpatient basis. After surgery, recovery will typically include immobilizing the arm, followed by a graduated therapy program to help regain strength and range of motion. Complete recovery can be expected to take 6 months.
Most rotator cuff tears can be treated without surgery with appropriate treatment. If you have shoulder pain, consult your physician to discuss your treatment options.
Edwin D. Vyhmeister MD, C. Hendrik Kirchhoff MD and Harold J. Kirkpatrick MD - Providing services in hand and wrist injury surgery, tennis elbow and shoulder therapy and tendinitis treatment to the areas of Everett and Seattle, Washington.
Everett Rotator Cuff Tear Treatment
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