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What is rotator cuff syndrome?

Rotator cuff syndrome involves irritation, damage, or degeneration of the rotator cuff, a vital component of the shoulder joint comprising four muscles and their tendons. This group of muscles and tendons are crucial for shoulder stability and a wide range of arm movements.

Rotator cuff syndrome involves any of the following degenerative condition or injury:

  • Rotator cuff tendinitis
  • Rotator cuff impingement
  • Rotator cuff tears

These injuries require prompt treatment, as chronic rotator cuff syndrome increases the risk of glenohumeral degenerative disease (osteoarthritis) and rotator cuff arthropathy.

rotator cuff syndrome singapore
Rotator cuff syndrome involves irritation, damage, or degeneration of the rotator cuff.

What causes rotator cuff syndrome?

Rotator cuff syndrome is caused by a combination of factors that can lead to the irritation, inflammation, or tearing of the rotator cuff muscles or tendons:

  • Repetitive use or overuse: activities that involve repetitive overhead arm movements, such as throwing, lifting, or reaching, can lead to irritation and inflammation of the rotator cuff tendons. Continuous strain on the shoulder joint without adequate rest and recovery can contribute to the development of rotator cuff syndrome.
  • Age-related degeneration: as people age, their tendons can deteriorate due to decreased blood flow and the natural ageing process, particularly in those over 50. This can result in tendonitis or tendinosis, both of which are common in rotator cuff syndrome.
  • Acute injuries: sudden impacts or injuries can cause tears in the rotator cuff tendons or muscles. Repetitive micro-trauma from activities like weightlifting or sports can also contribute to the development of rotator cuff syndrome over time.
  • Poor posture: chronic poor posture, such as forward head posture and rounded shoulders, can contribute to rotator cuff syndrome by causing abnormal mechanics and increased strain on the shoulder joint and surrounding structures.

What are the symptoms of rotator cuff syndrome?

Identifying rotator cuff syndrome early can help manage symptoms more effectively. Common signs of rotator cuff syndrome include:

  • Pain and discomfort: persistent shoulder pain, especially when lifting the arm, reaching overhead, or lying on the affected side. The pain may be dull, aching, radiating, or sharp, often localised to the front or side of the shoulder. Some individuals may experience more intense shoulder pain at night, disrupting sleep.
  • Shoulder weakness: shoulder weakness or instability is characterised by difficulty and weakness when lifting objects or performing movements that involve the shoulder.
  • Reduced mobility: rotator cuff syndrome is often characterised by a limited range of motion in the shoulder, making daily tasks challenging.
  • Swelling and tenderness: inflammation around the shoulder joint, leading to swelling and tenderness to the touch​.
  • Clicking or popping sensations: some individuals with rotator cuff syndrome may experience clicking, popping, or grinding sensations in the shoulder joint, particularly with certain movements. These sensations may indicate inflammation or irritation of the tendons and other structures in the shoulder.
  • Muscle atrophy: in severe cases of rotator cuff syndrome, muscle weakness and disuse may lead to muscle atrophy (wasting) in the muscles surrounding the shoulder joint. This may result in visible changes in the shape and appearance of the shoulder, particularly in the deltoid and rotator cuff muscles.
chronic shoulder pain
Persistent shoulder pain, especially when lifting the arm, reaching overhead, or lying on the affected side, is a symptom of rotator cuff syndrome.

Who is at risk of rotator cuff syndrome in Singapore?

Factors increasing the risk of RCS include:

  • Age: as people age, the tendons in the rotator cuff become less elastic and more prone to degeneration, making them susceptible to injury and inflammation. Individuals over 40 are at higher risk due to tendon degeneration.
  • Genetics: some individuals may be predisposed to rotator cuff syndrome due to genetic factors that affect tendon health and integrity. Certain genetic conditions, such as hypermobile joints or collagen disorders, can increase the risk of tendon injuries and degenerative changes in the shoulder joint.
  • Jobs or sports: physical activities that involve repetitive shoulder movements increase the risk. Athletes who participate in sports that require repetitive overhead motions, such as baseball, tennis, swimming, and volleyball, are at increased risk of developing rotator cuff syndrome. These activities can lead to overuse injuries and strain on the shoulder joint, predisposing individuals to rotator cuff tears and tendonitis. Jobs that require workers to do repetitive overhead tasks, such as painting or lifting objects, increase the risk of rotator cuff syndrome.
  • Poor posture: poor posture, particularly rounded shoulders and forward head posture can contribute to rotator cuff syndrome by placing excessive strain on the shoulder joint and surrounding structures. Prolonged sitting, improper lifting techniques, and desk-bound work can also contribute to poor posture and increase the risk of shoulder injuries.
  • Previous shoulder injuries: individuals with a history of shoulder injuries, such as dislocations, fractures, or sprains, may be at higher risk of developing rotator cuff syndrome. These injuries can weaken the shoulder joint and disrupt its normal mechanics, making it more susceptible to future injuries.

How is rotator cuff syndrome diagnosed?

Diagnosis of rotator cuff syndrome involves a comprehensive approach, including:

  • Medical history and physical examination: your pain specialist will inquire about your symptoms, onset and severity of pain, and any activities or movements that exacerbate or trigger symptoms. The area will be examined to assess your shoulder’s range of motion, strength, tenderness, and stability.
  • Imaging tests: imaging tests such as X-rays, magnetic resonance imaging (MRI), ultrasounds, and magnetic resonance arthrogram (MRA) may be conducted to visualise the soft tissues of the shoulder. MRI, X-rays, and ultrasounds can help visualise the extent of the injury and confirm the diagnosis.
  • Diagnostic tests: additional diagnostic tests, such as electromyography (EMG), may be conducted, if necessary, to check the nerve conduction and muscle activity of the affected shoulder.
shoulder MRI
An MRI of the shoulder will help identify rotator cuff syndrome.

What are the treatment options for rotator cuff syndrome in Singapore?

Treatment for rotator cuff syndrome depends on the severity, underlying cause, and the individual’s general health and preference. Treatment aims to relieve pain, reduce inflammation, and restore shoulder function, ranging from conservative methods to surgical interventions:

  • Rest and ice: Minimise the use of the affected shoulder and apply ice to reduce swelling. Individuals with rotator cuff syndrome may need to modify their daily activities, such as avoiding heavy lifting, repetitive overhead movements, or sports that involve throwing or reaching.
  • Physical therapy: physical therapy involves exercises to improve flexibility, strength, and range of motion of the affected shoulder, helping to prevent further straining or pressure on it.
  • Medications: pain-relieving medication such as nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce inflammation and alleviate pain.
  • Ultrasound-guided injections and Radiofrequency (RF) therapy: corticosteroid injections may be administered directly into the shoulder joint to relieve short-term pain and decrease inflammation. RF therapy to specific nerves may help alleviate pain and restore function.
  • Platelet-rich plasma (PRP) therapy: PRP therapy involves injecting a concentrated solution of platelets derived from the patient’s blood into the shoulder joint to promote tissue healing and regeneration. PRP therapy has been shown to be effective in some cases of rotator cuff syndrome, particularly in individuals with chronic or degenerative tendon injuries.
rotator cuff treatment
Corticosteroid injections or PRP may be necessary for severe cases of rotator cuff syndrome.

Frequently asked questions

Symptoms of rotator cuff disease include:

  • Dull ache deep in the shoulder
  • Disturbed sleep, especially if lying on the affected side
  • Difficulty with everyday activities such as combing hair or reaching behind the back
  • Arm weakness

Fixing rotator cuff syndrome involves both non-surgical and surgical options, depending on the severity of the condition:

  • Nonsurgical Treatments. These can include rest, ice packs, physical therapy exercises to improve strength and flexibility, pain relief medications, and steroid injections to reduce inflammation.
  • Surgical Options. Surgery might be considered for severe cases, especially if there is a complete tear or if nonsurgical treatments haven’t helped. Most surgeries are done arthroscopically, though the method may vary based on the injury’s specifics.

Rotator cuff syndrome doesn’t typically heal on its own without intervention. While non-surgical treatments can alleviate symptoms and improve function, they don’t heal the tear itself. However, many people can manage their symptoms effectively without surgery. The healing process can also take a considerable amount of time, and patience is key to managing the condition.

Rotator cuff pain can vary greatly from person to person. For some, it may feel like a dull ache in the shoulder, while for others, it could be a sharp, stabbing pain. Pain might worsen at night or when resting the arm. Some people experience immediate and intense pain following an injury, while others might have mild pain that gradually worsens over time. Many individuals also report arm and shoulder weakness alongside the pain.