MANUAL MINORS
The rotator cuff is a group of four muscles and their tendons (supraspinatus, infraspinatus, teres minor, and subscapularis) that surround the head of the humerus and stabilise the shoulder joint.
Rotator cuff injuries are common and can include tendinitis, partial, or complete tears, typically caused by repetitive arm movements, direct trauma, or ageing. These injuries are frequent among athletes, manual labourers, and older individuals.
Diagnosis
Diagnosis is suspected with the presence of shoulder pain, particularly when lifting the arm or performing overhead activities. Pain is often accompanied by weakness and functional limitations, especially in shoulder rotation and abduction.
Physical examination tests, such as the Jobe test (supraspinatus test), Neer test (impingement), and Hawkins test, help identify the injury. Diagnosis is confirmed through ultrasound or magnetic resonance imaging (MRI), which assess the degree of tear and tendon condition.
Differential Diagnosis
Pathology | Characteristics |
|---|---|
Bicipital tendinitis | Pain in the front of the shoulder, especially with flexion and supination of the arm |
Subacromial bursitis | Localised pain at the top of the shoulder, especially when lifting the arm |
Shoulder dislocation | Visible deformity after trauma, with limited mobility |
Shoulder osteoarthritis | Chronic pain, stiffness, and progressive loss of mobility |
Humeral neck fracture | Acute pain after trauma, with deformity and difficulty moving the arm |
Emergency Management
In the emergency setting, management includes immobilising the affected shoulder with a sling to reduce pain and prevent movement, along with non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics for pain control. In cases of acute tears following trauma, the patient should be referred for imaging and specialist evaluation. Ice application during the first 48 hours may help reduce inflammation.
Definitive Treatment
Treatment depends on the severity of the injury:
Mild injuries (tendinitis or partial tears): Conservative management includes rest, NSAIDs, physiotherapy to strengthen shoulder muscles and improve mobility, and activity modification to avoid exacerbating pain.
Severe injuries (complete or chronic tears): These may require surgical treatment, such as arthroscopic tendon repair. In severe or degenerative cases, shoulder replacement surgery (arthroplasty) may be considered. Postoperative physiotherapy is crucial to restore shoulder mobility and function.
In all cases, rehabilitation is essential to restore strength and prevent recurrence or complications such as joint stiffness or persistent weakness.
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