BY SUNNDEEP CHOPRA
Rotator cuff tendinitis (inflammation of the tendons) or then tear of the rotator cuff is one of the most common causes or reasons for shoulder pain. The rotator cuff is formed by a combination of the tendons (or sinews is a tough band of fibrous connective tissue that usually links up or then connects muscle with bone) of the supraspinatus (relatively small muscle in the upper arm region), infraspinatus (muscles connecting the upper extremities to the vertebral column) teres minor and subscapularis muscles.
Minute or fine adjustments of the humeral head (bone in the vicinity of the elbow) within the glenoid is achieved by coordinated activity or then in tandem with four inter related or then ointer-connected muscles arising from the scapula (shoulder blades) and is called or christened as the rotator cuff.
Incidence or occurrence of rotator cuff related injuries or tears is around the 30% mark in people below the seventy year mark. 60% in people between 71-80 years of age and 70% in those people who live to see the ripe old age of 90.Rotator cuff lesions or injuries (tears) are a problem commonly associated or linked with the supraspinatus tendon. Other minor or then trivial contributory factors or reasons include bicipetal tendinitis but they are normally the exception rather than the rule.
TORN ROTATOR CUFF SYMPTOMS: Rotator cuff tendinitis is indicated or alluded to by pain on active flexion, stretching or then movement of the arm and shoulder (but not passive abduction), pain in the region of or then over and above the lateral deltoid muscle that is usually exacerbated or then aggravated at night and overwhelming evidence of the impi ngement sign (feeling or then experiencing a sensation of intense pain whenever the arm is held straight out in front or then flexion of the arm in a straight line). This maneuver is performed by the examiner or specialist by raising or extending the patient’s arm into a forced flexionary posture or position while stabilizing and hindering rotation of the scapula simultaneously.
Any incidence or then experiencing of pain before the completion of 180 degrees of forward flexion is usually taken to be a positive sign and most commonly is a byproduct of traumas or injuries to the arm. A resoundingly complete tear of the rotator cuff is s far more common occurrence amongst the elderly and again results from trauma or injury; the same may manifest or announce itself in the same manner as tendinitis but is far less common.
The diagnosis or end result is also suggested or hinted at by the patient’s pronounced inability to maintain the extended position of his/her arm for a considerable period of time even when in a passive position or state. The diagnosis is doubly confirmed or underlined when the patient fails to hold up his arm once the figure of 90 degrees of abduction is achieved or reached. Tendinitis or then tear of the rotator cuff can also be established by subjecting the patient to either an MRI or then ultrasound test.
TORN ROTATOR CUFF TREATMENT: This generally tends to be conservative i.e. through the administration of non steroidal inflammatory drugs, application of pain inhibiting creams or gels, focusing infra red waves on the affected area through a pin pointed or focused source or then with the aid of slings or bands. Surgical arthroscopic or exploratory repair is resorted to depending upon the severity or seriousness of the tear in the rotator cuff region.
TORN ROTATOR CUFF EXERCISES:
Physiotherapy in rotator cuff tears or Lesions:
Ø Isometric Exercises: or strength training exercises to the deltoid and other shoulder muscles.
Ø Thermo (heat) Therapy : in the form of ultrasound, SWD, TENS or then in any other form is found to be of some help in relieving the associated pain.
Ø Mobilisation: gradual active and passive mobilization of the shoulder (movements for the shoulder).
Ø Exercises: gravity eliminated or obviated exercises, pendulum swings, flexion of the arm and extension of the same and progressive resistive exercises are found to be immensely beneficial in the alleviation or improving of this condition.
During the Initial Acute Stage:
a. Complete immobilization of the affected arm with the aid of a sling.
b. Thermotherapy: as an aid in the control and abation of the initial pain and stiffness.
c. Exercises: active though not strenuous exercises of the hand, wrist, forearm and elbow.
During the later (latter stages):
The following measures are actively advocated or advised as the associated pains begin to subside or abate.
- Isometric exercises of/to the abductors, flexors and extensors of the shoulder joint muscles.
- Passive exercises: with the patient lying straight in either a prone or then supine position relaxed or then gradual passive mobilization of the shoulder joint is initiated.
- Active exercises: can be further classified as either gravity eliminated or anti-gravity exercises the exercises are generally initiated or done with a second person aiding in the carrying out of the exercises with the patient lying in a supine position either on his back, side etc.
- Anti-resistance Exercises: this is the final set of exercises and all these exercises are carried out or conducted against a counter resisting weight or counter force dumbbells and weights are also found to be useful aids in these exercises.
INVESTIGATIONS OR DIAGNOSIS: X-rays, arthrography and arthroscopy are the most significant diagnostic tools taken recourse to or then adopted to confirm the existence of a rotator cuff injury or torn rotator cuff.
Preventive Measures: Rotator cuff tears/ torn rotator cuffs or then lesions can be severely curbed by adopting the below mentioned measures:
Ø Adequate or proper toning and conditioning of the shoulder girdle muscles through the adoption of a set or sets of the recommended or desired exercises.
Ø Avoiding certain sports that are associated or linked with the increasing incidence of shoulder related injuries or then identified as major contributory factors in their incidence.
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