Rotator Cuff
Injuries
What is a Rotator cuff Injury?
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1. Sprain:
- Definition: A sprain in the rotator cuff occurs when there is damage to the ligaments that connect the bones in the shoulder joint. Ligaments are tough bands of fibrous tissue that provide stability to the shoulder.
- Mechanism of Injury: Rotator cuff sprains typically result from a sudden impact, force, or twist that pushes the shoulder joint beyond its normal range of motion. This overstretching or tearing of the ligament causes the injury.
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2. Strain:
- Definition: A strain in the rotator cuff involves damage to the muscles or tendons that connect the muscles to the bones in the shoulder.
- Mechanism of Injury: Strains often occur when the rotator cuff muscles or tendons are overstretched or subjected to sudden, forceful contractions. This can happen due to repetitive overhead activities, heavy lifting, or sudden movements.
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3. Tear:
- Definition: A rotator cuff tear is a more severe injury where one or more of the tendons in the rotator cuff are either partially or completely torn.
- *Mechanism of Injury:* Tears can result from a single traumatic event, such as a fall or lifting something too heavy, or from chronic wear and tear over time. The injury leads to pain, weakness, and difficulty in moving the shoulder.
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Injury Severity Grades
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- Grade 1 (Mild): Involves minor stretching of the rotator cuff muscles, tendons, or ligaments without tearing. Symptoms include localised pain, mild swelling, and stiffness. Recovery is usually quicker, requiring rest and conservative treatment.
- Grade 2 (Moderate): Characterised by partial tearing of the muscles, tendons, or ligaments in the rotator cuff. Symptoms include increased pain, swelling, and reduced range of motion. This grade typically requires a longer recovery time and may necessitate medical intervention.
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- Grade 3 (Severe): Involves a complete tear of one or more of the rotator cuff tendons or ligaments. This results in significant pain, substantial loss of function, and may require surgical intervention. Recovery is extensive, often involving physical therapy and a prolonged healing period.
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Summary:
The key differences in rotator cuff injuries lie in the structures affected and the severity of the injury. Sprains involve ligaments, strains affect muscles or tendons, and tears refer to complete or partial tears of the tendons. Understanding the specific type and grade of the injury is essential for accurate diagnosis and effective treatment.
Symptoms
1. Sprain:
- Pain: Mild to moderate pain around the shoulder, especially when moving the arm.
- Swelling: Possible swelling in the shoulder area.
- Stiffness: Difficulty in moving the shoulder, with a feeling of stiffness.
- Weakness: Mild weakness in the shoulder, particularly when trying to lift the arm.
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2. Strain:
- Pain: Sharp or aching pain in the shoulder, which may increase with movement.
- Muscle Spasms: Possible muscle spasms in the shoulder area.
- Weakness: Noticeable weakness in the shoulder, making it difficult to lift objects or perform overhead activities.
- Limited Range of Motion: Difficulty moving the shoulder fully due to pain and tightness.
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3. Tear:
- Severe Pain: Intense, sudden pain in the shoulder, especially during movement.
- Weakness: Significant weakness in the shoulder, making it challenging to lift the arm or carry objects.
- Limited Mobility: A substantial decrease in the range of motion, often accompanied by a popping or clicking sound when moving the shoulder.
- Swelling and Bruising: Swelling and possible bruising around the shoulder area.
- Night Pain: Pain that worsens at night or when lying on the affected shoulder.​
Treatment
Depending on the severity of the rotator cuff injury and the phase of recovery, the course of treatment will be determined. It is recommended that the patient book the Hercules Injury Package, which includes:
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- Assessment: Evaluate range of motion (ROM), strength, posture, and pain to determine the optimal treatment plan.
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- Treatment:
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- Acute Stage (Initial Phase): If the assessment indicates the injury is acute, the treatment protocol will include:
- Dry Needling: To relieve muscle tension and pain.
- Low-Duty-Cycle Ultrasound Therapy: To decrease inflammation and promote healing.
- Cupping Therapy: To enhance blood flow and relieve muscle tightness.
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- Subacute or Chronic Stage: If the assessment indicates the injury is in the subacute or chronic stages, the treatment will involve:
- Soft Tissue Release (STR): To address and release muscle tension.
- Massage Therapy: To reduce muscle tightness and improve circulation.
- Hot Stones: To relax muscles and improve blood flow.
- Ultrasound Therapy: For deep tissue heating and continued inflammation reduction.
- Instrument-Assisted Soft Tissue Mobilisation (IASTM): To break down scar tissue and improve tissue function.
- Reassessment: Regular evaluations to monitor progress and adjust treatment as needed.​
- Rehabilitation Plan:
- Rehabilitation Exercises: Tailored exercises to restore strength, flexibility, and function in the rotator cuff.
- Resistance Band Exercises: To address weaknesses and improve stability in the shoulder.
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- Surgical Consideration: Depending on the severity of the injury, particularly if there is a complete tear or rupture of the rotator cuff, surgery may be required. The need for surgical intervention will be determined based on the assessment findings and may be recommended to repair significant tendon damage and restore normal function.
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This comprehensive approach ensures effective treatment of the injury and supports a full recovery by addressing both acute symptoms and long-term rehabilitation needs, with the possibility of surgical intervention if necessary.