Treating Rotator Cuff Injuries By Louis Neipris, M.D. HealthAtoZ writer
If your job or exercise routine requires repetitive lifting, you may end up with a rotator cuff injury. You can also injure your rotator cuff in a fall, playing sports, or lifting something heavy. These injuries occur in the shoulder and upper arm. Most are successfully treated with medication and physical therapy. Surgery may be needed for torn tendons, dislocations and other problems that limit movement. Visiting the doctor Be prepared to tell your doctor about any accident you may have had. Do you remember when you first felt pain? Did you fall on your shoulder? Did you feel a sharp pain when playing tennis or hear a popping sound while lifting weights in the gym? Overuse of the shoulder in everyday activities can gradually lead to pain and injury. Your doctor will ask if you do anything that involves repetitive lifting of your arm above your head. Tell your doctor how you treat the pain and if it helps. Your doctor may order tests, such as:
- A shoulder x-ray. Helps to rule out a fracture. May be able to identify calcium deposits, which indicate previously healed injuries.
- Arthrography. Dye injected into the shoulder joint allows soft tissue to show up on x-ray. This helps show tendon tears and joint swelling.
- Shoulder MRI. Provides details of a tendon tear - including location, size and the state of its corresponding muscle.
Treatment Active rest "Active rest" is a form of pain relief. You continue to move your shoulder, but refrain from activities that cause pain or may have led to the injury, including the following:
- Moving the arm above the shoulder.
- Heavy lifting, pushing or pulling.
Medications
- Nonsteroidal anti-inflammatory medications (NSAIDs) - such as ibuprofen - reduce tenderness and swelling. However, NSAIDs are not for everyone, including those with stomach problems, liver, kidney, or heart disease, among other conditions. Talk to your doctor before taking NSAIDs.
- Steroid injection. Corticosteroid medication is injected into the joint to reduce pain and swelling. Your doctor may give you more than one injection, depending on how well you do.
Rehabilitation therapy This therapy involves exercises to restore full movement. A physical therapist treats the shoulder with exercises and shows you how to do them on your own.
- Range of motion exercises. Your physical therapist moves your injured side through its full range of motion and shows you exercises to do on your own. You're instructed in stretching and warming up without overexerting your shoulder. Ice is applied after your session to minimize swelling. Range of motion exercises help prevent a "frozen" shoulder.
- Strengthening exercises. As your pain subsides, you're instructed in resistance exercises using light weights. Low weight and lots of repetitions build rotator cuff muscle strength gradually.
Physical therapy can last several weeks or months. Surgery Surgery is recommended if pain continues after rehab and appropriate treatment or if the arm becomes weak. The decision to do surgery also depends on the type of shoulder injury. It can repair a tendon tear or other damage within the shoulder joint. Surgery is done openly, with a larger incision, or closed, with arthroscopy. With arthroscopy, numbing medication is given and pencil-thin incisions are made. A camera is passed through one hole to see inside the joint. Instruments are passed through the other holes to repair damage. There is less tissue damage with the closed procedure, but sometimes the open procedure is necessary. Both procedures require rehabilitation and physical therapy. Sources: National Guideline Clearinghouse Agency for Healthcare Research and Quality American Academy of Orthopedic Surgeons American College of Sports Medicine
This article was reviewed and updated June 2007.
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