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Jess Schmitz

March 29, 2011


Rotator Cuff Tear Paper
It is one of the darkest fears of pitchers, tennis players, as well as many other athletes; a
rotator cuff tear. At worst, a rotator cuff tear can end a players career. So what is it exactly? The
rotator cuff is a group of four tendons and muscles (teres minor, infraspinatus, supraspinatus,
subscapularis) that converge around the top of the humerus, the upper arm bone above the elbow.
Together, they form a cuff that both holds your arm in place and allows it to move in different
directions. While your shoulder is one of your most mobile joints, its also somewhat weak. Too
much stress or too many fastballs can cause partial tears and swelling in the tendons of the
rotator cuff. Abrupt stress may even cause one of the tendons to pull away from the bone or tear
in the middle of the tendon. Rotator cuff tears are sometimes incorrectly called rotary cuff
tears. The supraspinatus and infrapsinatus are the most commonly injured rotator cuff muscles
and are injured usually when bowling in cricket, pitching in baseball, swimming, kayaking, or
other activities that put stress on a persons arm. In Rotator Cuff Tears: Clinical, Radiographic,
and US Findings, they say that the most sensitive clinical findings are impingement and the arc
of pain sign. In more chronic cases, and outlet view may show decreased opacity and decreased
size of the supraspinatus muscle due to atrophy. Many of these injuries may also occur from
tendinitis, bursitis, a strain or tear, normal wear and tear, or poor posture. If someone falls such
as a dive in baseball, or lifts or pulls something the wrong way will cause an injury. So will
repetitive stress.
Rotator cuff injuries can come in two different types of tears, acute and chronic tears. An
acute tear results of a sudden powerful movement which may include falling over onto an
outstretched hand at speed, making a sudden thrust with the paddle in kayaking, or a powerful
pitch. There will be a sudden, tearing feeling in the shoulder followed by severe pain in the arm.
There will be limited movement of the shoulder due to pain or a muscle spasm. There is also
tenderness in a specific spot and a person will not be able to abduct his or her arm or raise it out
to the side without assistance. A chronic tear is one that develops over a long period of time and
usually occurs at or near the tendon, as a result of the tendon rubbing against the overlying bone,
thus impingement syndrome. This is usually found on the dominant side and this affects people
who are usually 40 years old and older. Pain is worse at night and can affect sleeping habits. The
patient will eventually be unable to abduct their arm without assistance or do any activities with
the arm above the head. Along with these symptoms, there is also weakness and tenderness in
the shoulder, difficulty moving and there is snapping or crackling sounds when the shoulder is
moved.
If the injury appears to be severe or the doctor cant determine the cause of the persons
pain through physical examination he or she may recommend diagnostic imaging tests to better
delineate the shoulder joint, muscles, and tendons. An x-ray may be used as well as an MRI and
an ultrasound scan. There are various rotator cuff tests that doctors can use to diagnose a tear.
The empty can test is the most common test used to find out if there is a supraspinatus injury.
The athlete will be asked to abduct their arm 90 and act like they are holding a full can. Then
the athlete will resist the pressure of the doctor pushing down on their arm and if they are able to
hold their arm up they are not injured. After, the athlete will be asked to rotate their arms 30 and
act like they have emptied the can and they will again resist the doctors pressure. Next, there is
the Gerbers Lift Off test which tests the subscapularis by whether or not you can hold your
hand on your back. Along with these two tests, there is the Drop Arm Test which tests if the
rotator cuff is torn because if it is, the athlete wont be able to hold their arm in place as they
slowly lower it to their side. The Neer Impingement feels for instability and clumping in the
shoulder and the Hawkins Kennedy sees if there is a subluxation of the AC Joint.
Most of the time exercise therapy is used to treat a rotator cuff tear by showing different
exercises designed to heal the injury, improve flexibility of the rotator cuff, and shoulder
muscles. They can use steroid injections to help heal the tear, as well as surgery can be
performed called Arthroscopic Rotator Cuff Repair Surgery. They perform the surgery without
making the larger incision which classically has been necessary to treat rotator cuff tears. During
an arthroscopic rotator cuff repair, we insert a series of cannulas into the shoulder joint through a
small number of incisions and then are able to visualize the rotator cuff tear and repair it.
Sometimes the rotator cuff may tear within the tendon, where its repaired in a side-to-side
fashion. Then the tendon where its torn from the bone will be repaired separately. (Arthroscopic
Treatment of Chronic Calcific Tendinitis with Complete Removal and Rotator Cuff Tendon
Repair). Most people who have had surgery have a recovery time of around four to six months
before they can resume full activity. Different sports have different recovery times depending on
what the motion that is being made by the shoulder. Swimmers and runners should wait three
months before returning to action. Bowling requires at least a four to six month recovery period,
as well as golfers. Tennis, baseball, softball, and racquetball players require at least a six month
recovery period. If you play sports such as football, hockey, downhill skiing, and wrestling, you
should wait at least a year before coming back to your sport. And, lifting heavy weights also
requires at least a yearlong recovery period.
If youve had a rotator cuff injury in the past, daily shoulder stretches and a shoulder
strengthening program can help prevent a recurrence. You should do regular shoulder exercises
and take frequent breaks at work if your job requires repetitive arm and shoulder motions. You
need to rest your shoulder regularly during sports that require repetitive arm use and always
apply cold packs and heat pads when you experience any shoulder pain or inflammation.
In order to prevent and strengthen the rotator cuff you can do a lot of stretches and
exercises. Start by lying on your stomach on a table or a bed. Put your left arm out at shoulder
level with your elbow bent to 90 and your hand down. Keep your elbow bent, and slowly raise
your left hand. Stop when your hand is level with your shoulder. Lower your hand slowly.
Repeat the exercise until your arm is tired. Then do the exercise with your right arm. Another
exercise you can do is lie on your right side with a rolled up towel under your right armpit.
Stretch your right arm above your head. Keep your left arm at your side with your elbow bent to
90 and the forearm resting against your chest, palm down. Roll your left shoulder out, raising
the left forearm until its level with your shoulder. Lower the arm slowly. Repeat the exercise
until your arm is tired. Then do the exercise with your right arm. Next, lie on your right side.
Keep your left arm along the upper side of your body. Bend your right elbow to 90. Keep the
right forearm resting on the table. Now roll your right shoulder in, raising your right forearm up
to your chest. Lower the forearm slowly. Repeat the exercise until your arm is tired. Then do the
exercise with your left arm. The fourth stretch you can do is in a standing position, start with the
right arm halfway between the front and side of your body, and thumb down. Raise your right
arm until almost level. Dont lift beyond the point of pain. Slowly lower your arm. Repeat the
exercise until your arm is tired. Then do the exercise with your left arm.
So basically, a rotator cuff is made up of four muscles, teres minor, infraspinatus,
supraspinatus, and the subscapularis, and they connect the upper arm bone, the humerus, to the
shoulder blade and help hold the ball of the humerus firmly in socket. Many different things can
affect a rotator cuff injury can cause it, and the best thing to do is always stretch before you
throw a ball or go swimming or perform any act of a shoulder motion. And once a person gets a
rotator cuff tear, he or she will have to go through surgery and many therapies in order to
recover. The recovery time changes depending on every sport and which motions are occurring
in every sport. So in order to prevent this injury, people need to stretch and strengthen their arm
muscles and they will remain healthy and without pain.

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