Putting our shoulder into our work

For pitchers, quarterbacks and carpenters, it can be a career-limiting — or ending — injury. Likewise, if you do manual labor or projects involving lifting, carrying or moving objects, it can sideline you for months. Even working out in the gym, swimming or playing tennis can cause this injury, but the most common catalyst, affecting millions of Americans annually, is advancing age and the normal wear and tears of life.

The culprit is a rotator cuff injury. The rotator cuff is a group of four tendons and muscles that converge around the shoulder joint at the top of the humerus, the upper arm bone above the elbow. Together, they form a ”cuff” that both holds our arm in place and allows it to move in different directions. While our shoulder is one of our most mobile joints, it’s also somewhat weak. Too much stress — or repetitive motion — can cause partial tears and swelling in the tendons of the rotator cuff. Abrupt stress may even cause one of the tendons to pull away from the bone or tear in the middle of the tendon.

Sometimes the shoulder blade is rough or abnormally shaped and rubs or scrapes the tendon. Over time, this can cause tiny tears and bleeding. When these tears heal, the scar tissue is weaker and less flexible than normal tendon, so the whole rotator cuff gets weaker. The weaker the tendon becomes, the greater its chances of tearing.

Most rotator cuff tears develop gradually. But they also can happen suddenly — you might feel a pop, intense pain, and weakness in the arm. Falls, lifting heavy luggage, even shoveling snow or working in the garden can aggravate our shoulders, especially as we age. Aging causes tendons to wear down, which can lead to a tear. Also, previous injuries and genetics may play a role in increasing susceptibility to rotator cuff injuries.

If the shoulder is very painful and motion is limited, or if you have numbness, tingling and a “pins and needles” sensation that travels down through your elbow and into your hands, you should consult your physician, orthopedist, or sport medicine specialist. Without treatment, rotator cuff disease may lead to permanent stiffness or weakness and may result in progressive degeneration of the shoulder joint.

Typical symptoms of a rotator cuff tear include:

  • Pain in the shoulder and arm, which varies depending on how serious the tear is
  • Weakness and tenderness in the shoulder
  • Difficulty moving the shoulder, especially when trying to lift our arm above our head
  • Snapping or crackling sounds when moving the shoulder
  • Inability to sleep on the shoulder

As bad as these injuries can be, the good news is that many rotator cuff tears heal on their own. They may simply require a little time and relative inactivity involving the injured shoulder. You also should:

  • Rest the joint as much as possible, and avoid any movement or activity that hurts. Some patients may require slings early in the healing process.
  • Ice the shoulder two to three times a day to reduce pain and swelling.
  • Perform range-of-motion exercises, if your doctor recommends them.
  • Consider physical therapy to strengthen the joint and to learn safe, supportive exercises.
  • Use anti-inflammatory painkillers, or NSAIDS, like Advil, Aleve, or Motrin. However, these drugs can have side effects, like an increased risk of bleeding and ulcers. They should be used only occasionally, unless your doctor specifically says otherwise.

More serious rotator cuff tears require surgery. One procedure is shoulder arthroscopy, usually an outpatient procedure. During arthroscopy, the patient is put to sleep with general anesthesia. A small camera is inserted into the shoulder to see the injury, and miniature tools are used to repair the rotator cuff tear. In some situations, an open tendon repair may be a better option. In these types of surgeries, your surgeon works through a larger incision to reattach the damaged tendon to the bone. Open tendon repairs typically have a longer recovery time than that seen with more minimally invasive procedures done arthroscopically.

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