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Rotator Cuff Syndrome of the Shoulder

The rotator cuff muscles of the shoulder are four fairly flat or sheet-like muscles and tendons which surround the top and back of the main shoulder joint. These function to help stabilize the shoulder as well as move the shoulder in several directions (for example raising and rotating the upper arm.) They attach at one end to areas on the shoulder blade, and the other end on the upper arm bone near the shoulder.

Pain will occur when one or more of these muscles becomes torn, pinched or inflamed. When the tendon attached to the muscle is inflamed, it is called tendinitis. If a muscle is completely torn, weakness develops as well. Sometimes, a hole will occur through the muscle or tendon, but the painful muscle will continue to function.

Strenuous and often repetitive activities may cause injuries in the rotator cuff. An injury to the rotator cuff from unusually heavy or sudden stretching of the arm or falling may cause injury of the rotator cuff as well. Frequently, activities such as prolonged overhead use of the arm (such as painting or pruning trees) may lead to rotator cuff problems. Calcium deposits or ‘bone spurs’ may develop on the undersurface of the collarbone joint near the point of the shoulder can hang down and rub or pinch the rotator cuff muscle underneath it and is called impingement syndrome.

When the shoulder is at rest there is less pain, but it usually will feel painful with raising the arm to the front or side, or lying on the shoulder at night. Pain may actually be felt most on the side of the upper arm, sometimes down almost to the elbow.

Along with a history of any injury or abnormal stress on the shoulder, an examination using specific motions may suggest a problem with the rotator cuff. Usually X-rays are done, but because the rotator cuff is made of soft tissues, X-rays or CT scans are often not sufficient. An MRI often shows if there is a tear or inflammation in the rotator cuff. The best way to confirm an unclear diagnosis is by directly looking at the area with an arthoscope.

The treatment of rotator cuff problems depends upon whether there is severe pain or a significant tear in some part of a muscle. In general, if pain does not improve with rest, medical evaluation is a good idea. Anti-inflammatory medications may be recommended. Physical therapy and exercises may be tried to reduce pain. If weakness is present, or the symptoms do not improve, X-rays, MRI or ultrasound may be ordered to make sure the muscles or tendons are not torn. For severe cases, arthroscopic surgery may be performed, where an orthopedic surgeon uses an arthroscope and instruments to examine and repair the problem.

Various medications may be used to reduce pain. These may include over the counter medications such as Tylenol (generic = acetaminophen) Aleve (generic = naproxen), Motrin (generic = ibuprofen) or aspirin. Prescription medications which belong to a group of medications called ‘non-steroidal anti-inflammatory medications (or ‘NSAIDs’ for short) are commonly recommended. Some of the more commonly prescribed of these include medications such as Celebrex, Motrin, Naprosyn, Mobic, Voltaren, Relafen and Lodine. (a complete list is available at the reference below).

More severe pain may be treated with injections of cortisone-like medications into the region around the rotator cuff muscle. If the muscle is torn, an orthopedic surgeon may be consulted to determine if surgery is necessary to restore function and prevent further damage.

If you develop shoulder pain with exercise or exertion, please contact your physician as this may be a sign of heart disease.

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