Rotator cuff injury

A rotator cuff tear is an injury of one or more of the tendons or muscles of the rotator cuff of the shoulder. Symptoms may include shoulder pain, which is often worse with movement, or weakness. This may limit peoples’ ability to brush their hair or put on clothing. Clicking may also occur with movement of the arm. A rotator cuff tear is an injury of one or more of the tendons or muscles of the rotator cuff of the shoulder. Symptoms may include shoulder pain, which is often worse with movement, or weakness. This may limit peoples’ ability to brush their hair or put on clothing. Clicking may also occur with movement of the arm. Tears may occur as the result of a sudden force or gradually over time. Risk factors include certain repetitive activities, smoking, and a family history of the condition. Diagnosis is based on symptoms, examination, and medical imaging. The rotator cuff is made up of the supraspinatus, infraspinatus, teres minor, and subscapularis. The supraspinatus is the most commonly affected. Treatment may include pain medication such as NSAIDs and specific exercises. It is recommended that people who are unable to raise their arm above 90 degrees after 2 weeks should be further assessed. In severe cases surgery may be indicated. Rotator cuff tears are common. Those over the age of 40 are most often affected. The condition has been described since at least the early 1800s. Many rotator cuff tears have no symptoms. Both partial and full thickness tears have been found on post mortem and MRI studies in those without any history of shoulder pain or symptoms. However, the most common presentation is shoulder pain or discomfort. This may occur with activity, particularly shoulder activity above the horizontal position, but may also be present at rest in bed. Pain-restricted movement above the horizontal position may be present, as well as weakness with shoulder flexion and abduction. Epidemiological studies strongly support a relationship between age and cuff tear prevalence. Those most prone to failed rotator cuff syndrome are people 65 years of age or older; and those with large, sustained tears. Smokers, diabetes sufferers, individuals with muscle atrophy and/or fatty infiltration, and those who do not follow postoperative-care recommendations also are at greater risk. In a recent study the frequency of such tears increased from 13% in the youngest group (aged 50–59 y) to 20% (aged 60–69 y), 31% (aged 70–79 y), and 51% in the oldest group (aged 80–89 y). This high rate of tear prevalence in asymptomatic individuals suggests that rotator cuff tears could be considered a 'normal' process of aging rather than a result of an apparent pathological process. They are known to increase in frequency with age and the most common cause is age-related degeneration and, less frequently, sports injuries or trauma. Some risk factors such as increased age and height cannot be changed. Increased body mass index is also associated with tearing. Recurrent lifting and overhead motions are at risk for rotator cuff injury as well. This includes jobs that involve repetitive overhead work, such as carpenters, painters, custodians, and servers. People who play sports that involve overhead motions, such as swimming, volleyball, baseball, tennis, and American football quarterbacks, are at a greater risk of experiencing a rotator cuff tear. Generally, the incidence of rotator cuff tears or injuries increases by age while corticosteroid injection for pain relief increases the risk of tendon tear and delays tendon healing. The shoulder is a complex mechanism involving bones, ligaments, joints, muscles, and tendons. The two main causes are acute injury or chronic and cumulative degeneration of the shoulder joint. Mechanisms can be extrinsic, intrinsic or a combination of both.