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Shoulder Pain at Night or When Lifting? You may have a Rotator Cuff Tear



ROTATOR CUFF TEARS


  • The rotator cuff is a group of four muscles that act as the main stabilizers of the shoulder joint

  • Injuries to one or more of the rotator cuff tendons can cause significant pain and disability

  • Rotator cuff tears can occur in any patient, but usually occur in older patients in the dominant arm

  • Tears can be complete or partial

  • 50% of painless rotator cuff tears become painful after 2-3 years

  • 50% of painful complete rotator cuff tears become larger at 2 years and bigger tears progress faster


CAUSES

  • Rotator cuff tears have numerous causes

  • The most common causes include

  • Trauma from a fall or lifting heavy objects

  • Degenerative in older patients

  • Repetitive overhead activities or longstanding impingement

SIGNS AND SYMPTOMS

  • Patients with rotator cuff tears have shoulder pain on the side of the tear that is worse with overhead activities

  • Patient with rotator cuff tears often have pain at night and pain when sleeping on affected side

  • Loss of motion and strength are common in patients with larger tears

TREATMENT

  • Treatment of rotator cuff tears is highly personalized and numerous factors are taken into consideration including patient age, type of tear, size of tear, chronicity of injury, etc.

  • The first line of treatment usually involves a course of physical therapy and a home exercise program focused on strengthening and stretching of the rotator cuff tendons and stabilizers of the shoulder

  • Anti-inflammatories such as ibuprofen are oftentimes helpful as an adjunct to other treatments

  • A steroid injection may be helpful decreasing symptoms, but does not promote healing

  • Partial rotator cuff tears that have failed conservative management may be treated with Platelet Rich Plasma (PRP) as there is growing evidence that this may help improve pain and avoid surgery

  • Surgery is reserved for cases that don’t improve after a course of conservative management if symptoms are significantly affecting activities of daily living and quality of life. Surgery is composed of an arthroscopic rotator cuff repair with multiple small portal incisions. Patients should expect to be in a sling for 6 weeks after the surgery and return to normal activities usually takes 3+ months from the time of surgery

PREVENTION

  • The best way to prevent this condition is to be mindful when lifting heavy objects, avoid repetitive overhead activities, and try to avoid falling directly on the shoulder

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