"Rotator Cuff Pain and How We Can Help"

"Doc, a few months ago I fell onto my shoulder. Since then, it aches when I lift my arms over head, sometimes awakens me from sleep, and just doesn't feel as strong as it used-to."

The symptoms described, especially in the 40 to 80 year old person, are those of a rotator cuff injury.

What the patient needs to know:"is the rotator cuff torn or just inflamed?"

Here at Watertown Chiropractic, Dr. Dingsor treats most patients in Watertown, SD and the surrounding areas with this type of problems. 

You can be assured that if you have a serious problem, Dr. Dingsor can refer you on to the proper specialist.

The Cause

The rotator cuff is a confluence of tendons that insert on the superior lateral aspect of the upper arm. The tendons are what permit the shoulder muscles (subscapularis, supraspinatus, infraspinatus, teres minor) to attach to bone, and therefore raise and lower the arm, and rotate it in and out. The tendons are broad, measuring approximately 5 centimeters in width, and form a cuff encapsulating the articular surface of the top of the humerus.

The rotator cuff runs under a bony and ligamentous arch formed by the acromion,(the bone felt when you put your left hand on top of your right shoulder) and is bordered by the acromioclavicular ligament, the coracoid (the bone in front of the shoulder), the acromioclavicular joint (where the clavicle joins the acromion. The rotator cuff muscles are the subscapularis anteriorly, the supraspinatus superiorly, and the infraspinatus and teres minor posteriorly.

Due to the narrowness of the space provided for the cuff, any inflammation or swelling of the tissue leads to pain. Any significant tearing of the cuff, weakens the ability of the muscle to move the arm, and eventually permits the articular cartilage in the shoulder joint to impact against the bony confines of the space, leading to pain and arthritis.

The Injury

When a person lands on the shoulder, the acromion bangs into the rotator cuff. Depending on the position of the arm, the strength and flexibility of the muscles and tendons, and the shape of the under surface of the acromion, either a bruise or tear of the rotator cuff can commonly occur.

If the cuff is bruised only, bleeding into the tendons occurs, the tendons swell, and pain increases. This entrapment of the swollen cuff may persist for months, increasing and decreasing in intensity usually related to activity. The entrapment of the rotator cuff is called the "impingement syndrome. " The syndrome is typically characterized by pain when the arm is in the overhead position, pain when twisting a screw driver or opening a bottle top, or pulling a cork, or when skiing. For the athlete, the pain is usually at the front of the shoulder.

If the rotator cuff is torn, the problem is significantly more serious. The symptoms are the same as for the impingement syndrome, with pain at night often being more prominent. The size of the tear must be determined by an arthrogram (where radiographic dye is injected into the shoulder joint and x-rays taken; how much leaks out as seen on x-ray, determines the size of the rotator cuff tear) or by Magnetic Resonance Imaging (MRI) (where pictures are taken in a magnetic field showing the internal structures of the joint.) If the cuff tear is significant, then surgery is generally recommended in order to prevent the humeral head from poking up through the rotator cuff tear to rub against the bony acromion. This superior migration not only produces pain and limited motion, but leads to significant arthritis of the shoulder joint. At surgery, the torn cuff is sewn back to itself, and reattached to the bony insertion on the lateral border of the humerus. Fortunately, many times this can be performed arthroscopically (using a small incision through which a thin tube is inserted to do the procedure). We routinely repair torn rotator cuffs under local (regional anesthesia with the patient awake) as an outpatient (no overnight stay required). Exercises are started the next day and the patient usually can return to full activities within months.

Rehabilitation and Treatment (click here to continue)