elbow ROTATOR CUFF INJURY

DEFINITION:

Encompassing entities such as “Impingement Syndrome”, “Rotator cuff tendonitis”, and “Rotator cuff tear”.
The rotator cuff describes the group of muscles/tendons that stabilize the shoulder joint.
Four muscles comprise the rotator cuff, originating from the scapula with attachments on the humerus. (See illustration).
Mechanical damage to the rotator cuff muscle/tendon unit.

MECHANISM OF INJURY / HOW IT OCCURS:

Can occur from a sudden trauma or may result from repetitive trauma “wear and tear”.
Repetitive overhead motions can lead to irritation and subsequent disruption of the tendon.
Often seen in activities such as pitching, throwing a football, swimming, or tennis.
A forceful pulling maneuver can lead to injury of the tendon.

SYMPTOMS:

Immediate pain in an acute injury and progressive pain in repetitive irritation.
Limited motion of the shoulder secondary to pain, especially overhead motion.
Difficulty sleeping, especially if lying on the affected side.
Weakness.

DIAGNOSIS:

Physical examination reveals pain with certain motions depending on which portion of the rotator cuff is involved.
Weakness to shoulder.
May see muscle atrophy if symptoms longstanding, often indicating rotator cuff tear.
Radiographic studies such as x-ray to evaluate for bone spurs, calcium deposits or a curved acromion (the bone acting as the roof of the shoulder). Also to evaluate for a narrow joint space suggesting a rotator cuff tear.
Magnetic resonance imaging (MRI) is helpful in defining structural changes.

TREATMENT/REHABILITATION:

Rest, ice and anti-inflammatory medications (NSAIDs), are used initially.
Rehabilitation to include stretching and strengthening is mandatory for the successful treatment and prevention of rotator cuff injuries. (See exercises for rotator cuff injuries).
A cortisone injection may be of benefit for both symptom management and for diagnostic confirmation. With impingement syndrome will get pain relief and maintain strength whereas weakness will persist if a rotator cuff tear is present.
Limit injections as cortisone may weaken the tendon.
Surgical intervention may be necessary for persistent symptoms of impingement and tendonitis or in the case of a rotator cuff tear.