During forceful throwing actions (e.g. tennis service, pitching and throwing), the rotator cuff has to work very hard. With repetitive throwing, the cuff is prone to being overloaded, resulting in inflammation and tissue breakdown.
Symptoms of Rotator Cuff injury include weakness, loss of full movement and shoulder pain. The amount of pain will depend on the extent of the injury. Patients with early-stage inflammation may only have pain with overhead activities, while those with a tear may not be able to sleep because of the pain.
Physiotherapists have a number of physical tests designed to diagnose the presence and severity of the injury, such as looking for signs of shoulder instability. X-rays can give clues as to the presence of an injury, but an MRI scan is the investigation method of choice to determine whether a tear is present. An ultrasound scan may be just as effective if carried out by an experienced sonographer.
Tears of the rotator cuff are best treated by surgical repair. Physiotherapy is often effective in treating acute (short-term) inflammation and chronic (long-term) degeneration of the cuff where a tear is not present.
The first aim of treatment is to reduce the amount of inflammation using ice therapy (never apply ice directly to the skin) and anti-inflammatory medication prescribed by a doctor. Anti-inflammatory gel may be more appropriate where anti-inflammatory tablets are not well tolerated. For those who want to continue with sports and work activities a shoulder support can provide support and reassurance.
Ice packs relieve pain and reduce bleeding in the damaged tissue.
Corticosteroid injection (an injection of a naturally occurring substance that can slow down inflammation) that bathes the rotator cuff, rather than being injected directly into it, is advocated by some doctors. However, even this may carry a risk of causing further damage and should be used with caution.
Once the inflammation and pain has settled, exercises to regain full movement can begin, followed by a carefully-graded strengthening and stabilizing programme. Resistance bands can be very useful for this.
Operative treatment of chronic inflammation and degeneration of the rotator cuff may be necessary if no progress is made with physiotherapy. The use of surgery aims to enlarge the subacromial space (subacromial decompression), thus reducing the risk of impingement.
For athletes, attention must be paid to flexibility, strength and endurance of the shoulder muscles, ensuring that the muscles of the scapula are not neglected. Learning the correct technique and choosing proper equipment are also important.
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