Rotator Cuff – Injury
Work Related Rotator Cuff Injuries By Michael W. Tanner, M.D.
Rotator cuff injuries are common in the work place and occur in many different types of workers. The rotator cuff is a set of tendons, which wrap around the head of the humerus to hold it secure to the socket. The purpose of the rotator cuff muscles and tendons are to provide security and balance to the shoulder joint. These muscles and tendons help rotate the arm at the shoulder joint.
The rotator cuff can be injured with a fall onto the arm. Commonly, rotator cuff injuries are the result of the arm being jerked overhead. A classic example is the train conductor who slips on a step while holding on to the railing and his arm is jerked overhead. The rotator cuff can also be injured when the arm is jerked downward. For example, a person carrying a heavy object that suddenly falls and pulls the person downward. This sudden downward traction on the arm could injure the rotator cuff.
The rotator cuff can also degenerate with age. If an individual has many heavy work duties and a growth of spurs around the shoulder, they may experience a pinching of the rotator cuff, thus causing a weakening and subsequent tearing of the tendon.
Common symptoms of rotator cuff injury are pain and difficulty raising the arm. Many people cannot lie on the affected shoulder and commonly report waking up at night with discomfort (especially if they roll onto their arm.) It is painful for those with a rotator cuff injury to try and reach behind their body. Reaching outward becomes painful and a person notices weakness when trying to lift objects.
They may experience difficulty lifting a carton out of the refrigerator. By attempting to move the joint a person may experience Crepitus, a noise of the joint. This noise may represent a pulling on the rip in the rotator cuff tendon.
A plain x-ray can reveal subtle signs of rotator cuff disease. Other imaging studies are magnetic resonance imaging (MRI) and arthrogram. These studies can be helpful in select cases. In addition, other problems of the shoulder joint can accompany rotator cuff injury and disease. Following an injury, physical therapy, medication and use of a sling are often used to help provide relief of discomfort and to maintain motion of the shoulder. If a person has a poor recovery in the first three to six weeks following the injury, surgical treatment may be necessary for the rotator cuff injury. Many people of working age will require surgery to regain full function of the shoulder and to relieve the accompanying pain.
In many active people, the rotator cuff tendon will not heal itself and requires a repair, or suturing, of the tendon back into the correct position. Commonly, an arthroscopic surgery is required to evaluate the situation and to clean and trim any bone spurs in the region. Many times, an incision is made over the torn area of tendon for a direct repair. The patient is hospitalized for approximately one to two days.
After rotator cuff surgery, a sling and pillow may be used for approximately three to four weeks. Often, physical therapy helps patients to regain motion. Strengthening exercises usually start at approximately six to eight weeks following surgical repair. A full recovery can take approximately three to six months depending on the rehabilitation and the physical demands placed on the shoulder. For example, an oil field worker may be away from his work duties for five to six months as compared to an office worker who may be able to return to restricted work duties within a few weeks.