The shoulder is the most commonly used joint in our body, this range of movements come at the cost of stability of the joint. However, this instability is compensated in part by a strong arrangement of muscles around the shoulder joint, which provide both the range of motion as well as stability to enable us do our daily activities involving shoulder. This group of muscles is called the rotator cuff muscles because they are arranged like a cuff around the shoulder. They act as an interface between the shoulder and arm. Due to this extensive involvement in activities, these muscles and their tendons are prone to getting involved in various pathologies around the shoulder.
These muscles are Subscapularis, Supraspinatus, Infraspinatus and Teres Minor. The most commonly involved muscle in rotator cuff pathologies is the Supraspinatus.
Rotator cuff pathologies can result from different causes, including abuse, injury, or degeneration because of ageing or different elements. Symptoms include pain around the shoulder, radiating down to upper arm, restricted activities involving the affected shoulder.
The common rotator cuff pathologies include-
- Rotator Cuff Tendinitis: An irritation of the rotator cuff ligaments that can causes discomfort and difficulty of movements in the shoulder.
- Rotator Cuff Tears: if the tendinitis is not taken care of, or in some cases, sudden jerky movements may result in tears involving the muscles. Tears can be partial or complete depending upon the extent of muscle involvement.
- Subacromial Impingement: When the rotator cuff ligaments rub against the acromion bone in the shoulder, it leads to discomfort and impingement.
- Rotator Sleeve Bursitis: This is an inflammation of the bursa sacs that cushion the rotator cuff ligaments.
Diagnosis and Treatment Options
Diagnosing rotator cuff pathologies involves history and clinical examination along with certain tests specific to test the muscle involvement. After ruling out any bony pathology by and X ray, the patient undergoes an ultrasound examination of the shoulder joint. The ultrasound exam of shoulder matches the MRI in confirming the diagnosis of shoulder pathologies. Based upon various diagnoses mentioned above, the patient may undergo injections around the tendons in case of tendinitis, or into the bursae in case of bursitis. Rotator cuff tears, respond very well to regenerative techniques like PRP or GFC injections into the tears, which help in healing of the tears and complete recovery can be expected.
In complete tears involving the rotator cuff tendons, surgical intervention may be required to fix the tendons depending upon the activity level of the patient.
Post procedure physiotherapy and rehab involving strengthening and gradual return to “range of motion” activity and exercises goes a long way in complete recovery in these conditions.
To sum up, although rotator cuff pathologies can be challenging conditions to manage, but with proper diagnosis, treatment, and rehabilitation, many patients can achieve a full recovery and return to their normal activities.
