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A rotator cuff is a set of muscles and tendons in the shoulder that connects the humerus (upper arm bone) with the scapula (shoulder blade). It allows the shoulder to rotate by securely holding the ball of the humerus in its socket. In fact, the rotator cuff allows this ball and socket to have the widest variety of motion among all the joints in the body.
There are four rotator cuff muscles, namely the infraspinatus, supraspinatus, subscapularis and teres minor. Every muscle is bound to the humerus by a tendon.
Rotator cuff diseases and conditions
Lifting heavy objects, among other activities, can tear a rotator cuff, especially if it has worn down over the years. Rotator cuff tears are painful, disrupting daily tasks, and cause continuous weakness in the shoulder.
Repetitive arm movements, particularly those performed overhead, e.g. throwing balls or reaching for high shelves, are known to inflame the rotator cuff tendons. This condition is called rotator cuff tendonitis or tendinitis.
Rotator cuff tendinitis makes arm and shoulder movements painful. Even lying on the affected shoulder can be excruciating. These symptoms also occur in a rotator cuff impingement, a condition wherein the humerus and an adjacent bone known as the acromion compress the tendons.
Subacromial bursitis happens when the bursa, the tendons’ fluid-filled cushion from the acromion, gets inflamed. Meanwhile, adhesive capsulitis (frozen shoulder) occurs when the humerus clings to the scapula.
Treating rotator cuff conditions
Rotator cuff injuries are usually self-limiting. In the meantime, they can be treated with RICE, i.e. rest, ice, compression and elevation.
If the pain proves unbearable, then corticosteroid injections can provide relief. Cortisone is one common injectable steroid, which works by reducing inflammation in the rotator cuff. Otherwise, the patient can choose NSAIDs (non-steroidal anti-inflammatory drugs) as pain relief.
In cases wherein the rotator cuff is so torn it has been severed from the bone, surgery is always needed. The doctor can perform surgery the old way, via a large incision, or through smaller incisions, taking advantage of an arthroscope. Both kinds of surgery can adhere the tendon to the bone again.
Healthy lifestyle experts encourage taking up physical therapy to strengthen the rotator cuff, improve its flexibility, and prevent certain conditions from compromising it. Alternatively, patients may undergo occupational therapy, which incorporates shoulder exercises into everyday activities.
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Tests for rotator cuff
Doctors can diagnose a rotator cuff injury by physically examining you. If you have difficulty moving your arm in its full range of motion, a rotator cuff tear is most likely. One way of determining this is by tilting the arm 90° and moving it towards the side.
For a more accurate diagnosis, doctors may either call for an MRI (magnetic resonance imaging) scan or a CT (computed tomography) scan. However, MRI scans are said to be more efficient in diagnosing rotator cuff conditions than CT scans.
An arthrogram can also confirm a rotator cuff injury. In this rotator cuff test, the patient’s shoulder is injected with dye, which would then mark the joint on the X-ray images.
However, basic X-rays cannot be used to detect a rotator cuff condition. But then again, simple X-rays can easily reveal bone fractures, abnormalities and spurs around the rotator cuff.