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A rotator cuff injury is either a tear to or inflammation of the muscles and tendons in your shoulder.
It commonly causes shoulder pain and occurs when the small muscles around the shoulder joint become inflamed. These muscles work together to stabilise the ball in the shoulder joint. Many sufferers find that wearing a shoulder support helps them to cope with this injury. The condition can make the shoulder feel unstable and wearing a shoulder support can give the sufferer increased confidence.
There are four rotator cuff muscles: supraspinatus, subscapularis, infraspinatus and teres minor. You may be told that you have injured one of these muscles, with supraspinatus being the most common, with suffers typically experiencing supraspinatus tendonitis. However, your doctor is unlikely to treat one muscle in isolation but will look at all four.
Shoulder pain, loss of full movement and weakness are typical symptoms. In the early stages of inflammation to the muscles, shoulder pain may only be felt when you reach over your head. However, if one of the rotator muscles is torn, the pain may be severe enough to stop you sleeping at night.
An MRI or ultrasound scan can be used to determine if any of the rotator cuff muscles are torn. A doctor will also look for signs of instability in the shoulder.
The rotator cuff muscles can become inflamed resulting in tendonitis. If this continues, small partial tears can result which may become complete tears that go all the way through one or more of the muscles.
Shoulder tendonitis or inflammation usually begins in one of three ways:
1. If you repeatedly reach above your head, perhaps reaching high shelves, or throwing a ball through a basket the rotator cuff can become squashed against the arc of bones and ligaments known as the coraco-acromial arch that stretches over it. This is known as primary impingement. Osteoarthritis can reduce the space between the arch and the rotator cuff which will also cause inflammation.
2. Some people find that their shoulders are lax, resulting in instability of the shoulder joint. This can be caused by an injury or have been present since birth. It may also be caused by stretching above the head repeatedly. As a result the rotator cuff will have to work hard to stabilise the ball joint in the shoulder and with time will become increasingly less able to prevent the ball joint from rubbing against the coraco-acromial arch. This is known as secondary impingement.
3. When we throw balls hard in tennis, cricket or other sports, the rotator cuff can become inflamed. Over time this may result in tissue breakdown.
If the pain is not too great your doctor may recommend exercises to build strength in the muscles and ice packs to reduce the inflammation. Corticosteroid injections may also be offered. Surgery may be used if the rotator cuff muscles are badly torn. A small amount of bone may be shaved away to create more space around the shoulder joint so that the rotator cuff can move more freely.
Tears are likely to repaired surgically but physiotherapy is effective when the muscles are inflamed only and there is no tear. Anti-inflammatory gel can reduce shoulder pain and wearing a shoulder support can give support and provide reassurance.