The shoulder is stabilized by a group of four muscles and tendons known as the rotator cuff.
A rotator cuff injury can be diagnosed as a strain, tendinitis or bursitis. Some injuries are caused by accidents or overuse, while others are caused by degenerative conditions.
This type of injury can be caused by overuse of the rotator cuff. Tennis players and painters are likely to experience tendinitis.
Bursitis is caused by inflammation of the bursa, which are fluid-filled sacs located between the rotator cuff tendons and the underlying bone.
Strains or tears may be caused by overuse or acute injury. Injury may be caused by a fall, car accident or another sudden injury.
Symptoms of Rotator Cuff Injury
Signs of a rotator cuff injury include:
- Avoiding certain pain-causing activities
- Difficulty achieving full range of shoulder motion
- Difficulty sleeping on the affected shoulder
- Experiencing pain or tenderness when reaching overhead
- Experiencing pain in the shoulder, especially at night
- Progressive weakness of the shoulder
- Difficulty reaching behind the back
Risk Factors for Rotator Cuff Injury
Individuals are at increased risk of degenerative rotator cuff injury if they are:
- Athletes, such as tennis players, baseball players, rowers or wrestlers
- Workers, such as painters and carpenters who have to make repetitive lifting motions
- Over the age of 40
Diagnosing Rotator Cuff Injury
Patients experiencing pain in their shoulder should schedule an appointment with their primary physician. During the initial visit, the physician will conduct a physical examination and ask about physical activities in the workplace. The doctor will test the patient’s range of motion and strength and rule out conditions with similar symptoms.
The results of an X-ray and MRI scan will help the physician identify any bone spurs, examine soft tissue, and identify tears. The scans will also help the physician determine the size and severity of the tears.
Depending on the severity of the condition, the injury may be treated by:
- Applying hot or cold packs to the injured shoulder to reduce swelling
- Engaging in exercise to restore strength and range of motion
- Resting the shoulder and wearing a sling
- Taking over-the-counter anti-inflammatory medications such as ibuprofen and naproxen
- Injecting the shoulder with cortisone to help reduce inflammation
Risks of Rotator Cuff Tendon Injection
Corticosteroids are the most commonly used substance in rotator cuff tendon injections. These steroids are inexpensive and have been used for many years. They are also very effective in reducing inflammation. The drawbacks of corticosteroids is that they inhibit collagen formation in the cartilage and tendon. The risks include:
- Tendon weakening and rupture
- Transient hypoglycemia
- Fat necrosis
Other (safer) substances that may be used instead of corticosteroids are hyaluronans and platelet rich plasma (PRP).
Patients should speak to their physician to find out if a rotator cuff tendon injection is the best option for their condition.
What to Expect During a Rotator Cuff Tendon Injection
A rotator cuff tendon injection can be performed using a posterior, lateral or anterior approach. The physician begins by cleaning the injection site with an antiseptic. Using ultrasound guidance, the steroid is injected into the bursa. The patient is able to return home the same day.