Thursday September 8, 2016
At London Doctors Clinic, we very often see patients with a variety of sporting injuries, one of the top ten sports injuries is certainly injury to the rotator cuff in the shoulder. Shoulder pain can be truly debilitating, and treatment for this should be sought for as soon as possible. Extended time without treatment for a rotator cuff injury could lead to a chronic problem. So, let's start from the top:
Shoulder Anatomy – the basics!
The shoulder joint is an intricate region. It is the site of the joining of three bones, between the shoulder, collar and arm. These three bones need to be stable enough for large amounts of force to be pass through them, whilst still maintaining the flexibility to allow diverse range of movements required for everyday activities.
To stabilise these joints there are strong ligaments and tendons but also a durable cuff of four muscles; called the rotator cuff. These muscles give off tendons that then insert into the head of the humerus, the long bone in your upper arm.
The movement of the rotator cuff.
Risk Factors of Rotator Cuff Injuries
Repetitive use of the joint is much more likely to aggravate any underlying problems that you may have, and cause wear-and-tear of the joint at a faster rate. Whether this usage is taking place on a sports pitch or during every day manual labour, it is much more likely to leave you at risk of developing a rotator cuff injury.
Age: It is a fact of life that no one gets any younger and unfortunately neither do your muscles or tendons. Deterioration of elastic property, and inability to repair as quickly as in your younger years leads means that these injuries become more prevalent in the over 40’s.
Family history: It’s thought that there is a possible genetic component to rotator cuff injuries; if you have relatives whom have suffered from some of the following symptoms before, why not pop in to see a GP today for a check up.
Rotator Cuff Injury symptoms:
- Pain in front of the shoulder and side of arm
- Loss of movement and/or strength in arm
- Swelling in front portion of shoulder and side of arm
- Pain that occurs when asked to raise or lower the arm
- Pain that occurs when asked to reach behind you
- Pain that causes to wake from sleep when lying on affected shoulder
- Crepitus or a crackling sensation in the affected joint
What could be causing these symptoms?
There may be an obvious cause for rotator cuff injuries, but often these are hard to narrow down without extensive investigation. Here are a few examples of the common causes of rotator cuff injuries:
Rotator Cuff Tears – A tear in one or more of the rotator cuff muscles can occur due to repetitive use or it may occur at a single traumatic event. The tear may be partial or complete; this depends whether the tear passes through the whole muscle piece or just partially. The symptomatic severity is dependent on the extent of damage to the tendons and muscle tissue.
Calcific tendinitis– this is an inflammatory condition of the tendons. The calcific component is regarding the build-up of calcium in the tendons of the rotator cuff. The discomfort that occurs through calcific tendinitis is due to the inflammatory response to this build-up of calcium and the physicalpressure that the calcium applies to the tendons. The exact cause of calcific tendinitis is not clarified and it often clears up by itself.
Subacromial impingement - When the rotator cuff has a small tear or has been fatigued through repetitive use, this may cause the head of the humerus bone to be slightly incorrectly positioned in the shoulder joint, such as when lifting an arm into a raised position. This causes pain in the shoulder joint, and if left untreated, this can lead to development of arthritis and protrusions.
Rotator Cuff Tendinitis – this is referring to the tendons of the rotator cuff, with –‘itis’ meaning inflammation of those tendons. The inflammation commonly comes from an overuse of the shoulder joint; it is a common ailment of sports players. It is particularly prevalent in those who play sports that require an arm raised above their head. Following treatment, individuals who have rotator cuff tendinitis usually make a full recovery.
Tennis superstar Maria Sharapova suffered a rotator cuff tear requiring surgery in 2008. She later bounced back, winning the French open (pictured) just a couple of years later, in 2012.
If you’re suffering from any of the above symptoms, it’s possible you have an injured rotator cuff, and should seek medical care. We’d recommend booking in to see one of our private GP’s, who will be more than happy to help investigate the problem with you. Our doctor will begin by take a medical history from you and discuss your symptoms. They will then perform an examination of your shoulder region, looking for any abnormalities, areas of tenderness, and then will likely asses the joint’s strength and range of movement.
Further investigation may include one of the following:
Once a rotator cuff injury is diagnosed, the first step of shoulder injuries should be to conserve the injury from any further damage, such as by resting it and applying ice to the painful area. It’s best to also avoid any activities which cause you pain.
Physiotherapy is method of improving flexibility of the joint, and strengthening the rotator cuff. This can act as a way of preventing further injury and strengthening previous weaknesses in the shoulder area. Physiotherapy is a preferred option to surgical interventions.
Pain relief will likely be necessary regardless of the severity of the injury. There are a number of over-the-counter pain-relief or anti-inflammatory medications that you can use to help manage the pain, such as:
In rare cases stronger painkillers may be required, or sometimes steroid injections are used to relieve pain. Surgery is required for more serious cases that do not resolve with the other forms of treatment.
So if you’ve been struggling with shoulder pain and its impacting your daily life, please do book in for a private GP consultation at London Doctors Clinic today for 15-minute consultation, costing just £55. All of our GP's will are able to assist with rotator cuff injuries, with a couple of GP's having special interests in sports and exercise medicine - namely Dr Samantha Burrows and Dr Lisa Burton. Together, we'll start you on your path to pain-free shoulders!
By George Wall