Rotator cuff syndrome is damage to the rotator cuff, which is a part of the shoulder. The “cuff” is actually a group of four muscles and their tendons that work as a unit to hold the bones of the shoulder together, allowing individuals to lift their arms and reach overhead. Repetitive motion and overuse, along with individual variations in the anatomy of the shoulder and trauma can lead to rotator cuff injuries.
Rotator cuff syndrome is a disorder most frequently diagnosed in those whose work involves repeated or sustained raising of the upper arms more than 30° over horizontal, and is the most common injury in variety of sports. Such repetitive motion irritates the muscles and tendons by putting pressure against the bone at the top of the shoulder blade. When the arm is raised repeatedly, front edge of the shoulder blade (acromion) can rub across the rotator cuff (impingement syndrome or painful arc syndrome). If rotator cuff injuries are diagnosed early, causes can be identified and effective treatments implemented, thereby preventing further injury or deterioration.
Rotator cuff impingement syndrome is divided into three stages of severity. In stage I, swelling (edema) and/or bleeding (hemorrhage) occurs. Stage I is frequently associated with an overuse injury. At this stage, the syndrome can either be reversed or it can progress. In stage II, there is inflammation of the tendon (tendinitis) and development of scar tissue (fibrosis). Stage III frequently involves a tendon rupture or muscle tear and often represents years of fibrosis and tendinitis.
At risk for rotator cuff syndrome are those required to repeatedly move heavy weights over their heads, such as painters, welders, plate workers, and slaughterhouse workers. It can occur in athletes who engage in sports such as swimming, tennis, weightlifting, and baseball in which the arm is repeatedly raised over the head. Younger individuals are more likely to experience rotator cuff syndrome as a result of trauma, overuse, shoulder (glenohumeral) joint instability, or muscle imbalance. In older individuals, the syndrome is more commonly related to chronic wear and shoulder degeneration. Rotator cuff syndrome is most common in the dominant arm.
Stage I rotator cuff syndrome is found most often in individuals under age 25; stage II occurs most often in individuals between 25 and 40; stage III occurs mainly in individuals over age 50
In the beginning, symptoms are mild. Most patients complain of minor pain that’s present both during activity and at rest, pain radiating from the front of the shoulder to the side of the arm and sudden pain with lifting & reaching motions.
You may notice local swelling and tenderness in the front of the shoulder and pain and stiffness when you attempt to lift your arm. There may also be pain when you lower the arm from an elevated position.
As the problem progresses, you may have pain at night and you may lose strength and motion. You may have difficulty with activities that place the arm behind the back, such as buttoning or zippering. In advanced cases, loss of motion may progress to a “frozen shoulder.” In acute bursitis, the shoulder may be severely tender. All movement may be limited and painful.