Shoulder Rotator Cuff Disorders
Rotator cuff disorders are one of the most common causes of shoulder pain and there are three common conditions that can affect the rotator cuff:
- rotator cuff tears
- subacromial impingement
- calcific tendonitis.
The rotator cuff muscles interlock to work as a unit. They help to stabilise the shoulder joint and also help with shoulder joint movement. The four tendons of the rotator cuff muscles join together to form one larger tendon, called the rotator cuff tendon. This tendon attaches to the bony surface at the top of the upper arm bone (the head of the humerus). There is a space underneath the acromion of the scapula, called the subacromial space and the rotator cuff tendon passes through here. The subacromial space is filled by the subacromial bursa which is a fluid-filled sac which helps the rotator cuff to move smoothly. It has a large number of pain sensors.
Rotator cuff disorders are extremely common and can happen to anyone. Sometimes they are caused by an injury such as falling on to the affected arm; this is more likely to be the cause if you are aged under 40. Overuse, either through sport or profession, may be a cause but they can occur without any obvious cause.
The main symptoms are pain in and around the shoulder joint and painful movement of the shoulder. If there has been an injury, the pain may come on suddenly. Pain is worst when you use your arm for activities above your shoulder level which can affect your ability to lift your arm up and pain may be worse at night which affects sleep. Occasionally your shoulder or arm may also feel weak and you may have reduced movement in your shoulder. Some people feel clicking or catching when they move their shoulder.
Rotator cuff tears
The rotator cuff is very vulnerable to being damaged within the subacromial space. This can lead to a tear that is not only painful but also makes the shoulder weak. It can happen suddenly after a single injury or can develop gradually. Rotator cuff tears can be minor/partial or full/complete depending on the degree of damage to the tendon. Minor tears to the rotator cuff are very common and may not cause any symptoms at all but small tears may be very painful and larger ones less so. A tear can be seen on an ultrasound or MRI scan but not on X-ray.
Also known as subacromial pain syndrome, tendinitis, tendonitis, bursitis, trapped tendon.
As you lift your arm up, the rotator cuff pushes the top of the upper arm bone (humeral head) under the acromion. Anything that affects the cuff, such as minor tears or overuse after a period of inactivity, can lead to the humeral head not being pushed down properly. It therefore moves too close to the acromion. This causes pain. It can also happen due to problems with the bone of the acromion. These can include arthritis and bony spurs (protrusions).
Calcific tendonitis is the name given when calcium builds up in the rotator cuff tendon. It can cause an increase in pressure in the tendon and a chemical irritation. It may be extremely painful. The cause is not known but it can eventually go away without any treatment. It tends to be more common in people between 30 and 60 years of age.
The calcium deposit may affect the way the rotator cuff works causing subacromial impingement but calcium deposits are also seen in people with no symptoms.
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