There are three bones in the shoulder region, the clavicle (collar bone), the scapula (shoulder blade) and the humerus (upper arm bone). The scapula is a triangular shaped bone that has two important parts to it: the acromion and the glenoid. The three bones in the shoulder region form part of two main joints:
There are also a number of muscles, ligaments and tendons around the shoulder. Ligaments are fibres that link bones together at a joint. Tendons are fibres that attach muscle to bone.
The rotator cuff is a group of four muscles that are positioned around the shoulder joint. The muscles are named:
The rotator cuff muscles work as a unit. They help to stabilise the shoulder joint and also help with shoulder joint movement. The four tendons of the rotator cuff muscles join together to form one larger tendon, called the rotator cuff tendon. This tendon attaches to the head of the humerus (the bony surface at the top of the upper arm bone). There is a space underneath the acromion of the scapula called the subacromial space. The rotator cuff tendon passes through here.
There are a number of different problems that can affect the rotator cuff and lead to rotator cuff injury or inflammation. The commonest problems include:
Rotator cuff tendonitis is the most common cause of shoulder pain.
Rotator cuff tendonitis is caused by irritation and inflammation of the tendons of the rotator cuff muscles. It tends to have an acute (sudden) onset. There is often a specific preceding injury. It can happen because of recent overuse of the shoulder. For example, it can occur in athletes, particularly those who participate in throwing sports. In non-athletes, there may be a history of recent heavy lifting or activities involving repetitive movements of the shoulder.
The main symptoms are an acute (sudden) onset of pain and painful movement of the shoulder. Pain is worst when you use your arm for activities above your shoulder level. This means that the pain can affect your ability to lift your arm up to, for example, to comb your hair or dress yourself. Swimming, basketball and painting can be painful but writing and typing can produce little in the way of pain. Pain may also affect sleep.
Your doctor is usually able to make the diagnosis just by talking to you and examining your shoulder. They usually start by asking questions about your shoulder. These questions may include when your shoulder problems started, whether you have had any specific injury and what aggravates your shoulder problem.
Calcific tendonitis is treated in the same way with rest, anti-inflammatory drugs, steroid injections and physiotherapy. Rarely, surgery is needed. An alternative to surgery is a procedure called lithotripsy. In lithotripsy, shock waves are generated and delivered by an external power source to the affected tendon(s) using a specialised machine known as a lithotripter. This helps to break up the deposits of calcium.
If rotator cuff tendonitis is adequately treated, there can be complete recovery.
As discussed above, the rotator cuff tendon passes in the subacromial space (the space underneath the acromion part of the scapula, or shoulder blade). In impingement syndrome, the rotator cuff tendon gets 'trapped' in the subacromial space. The tendon is repeatedly 'scraped' against the shoulder blade which can eventually lead to fraying of the tendon. This means that the tendon weakens and is more likely to tear.
Rotator cuff impingement syndrome also causes shoulder pain. However, the pain tends to be more chronic (longstanding). The pain tends to be worse during activities when your arm is raised over your head. Pain can also be worse at night time.
Again, your doctor will usually diagnose rotator cuff impingement syndrome just by talking to you and examining your shoulder. You will experience the same painful arc as described above when your shoulder is moved.
The treatment for rotator cuff impingement syndrome is similar to that for rotator cuff tendonitis. You should rest from any activity that involves repetitive movement of the shoulder. This particularly includes overhead activity such as that performed by plasterers or painters and decorators. This may mean that you have to modify or change your work activities. However, be careful to keep your shoulder mobile so that it does not stiffen up. Painkillers, anti-inflammatories, physiotherapy and steroid injections can help.
If rotator cuff impingement syndrome is not recognised and treated promptly, it can lead to excessive wear and tear of the rotator cuff tendon. This in turn can lead to weakening of the tendon and the tendon can break, or rupture, causing a rotator cuff tear.
Rotator cuff tears are usually tears in the rotator cuff tendon rather than in the muscles themselves. In younger people, a rotator cuff tear normally happens as a result of trauma (injury) due to a fall or accident. In older people, they are often caused by rotator cuff impingement syndrome (see above). In impingement syndrome, repeated damage to the 'trapped' tendon means that the tendon frays, weakens and is more likely to tear.
Pain is the most common symptom of a rotator cuff tear. The pain tends to be over the front and outer part of the shoulder. It is worse when your shoulder is moved in certain positions. For example, when your arm is moved above your head on dressing or combing your hair, or moved forwards to reach for something.
About half of people with rotator cuff tears do well with just conservative treatment. That means the rotator cuff tears heal with treatment including rest, physiotherapy, painkillers, anti-inflammatories and steroid injections. Surgery is needed in the other half in whom this conservative treatment does not work.
If you have OA of your hip or knee, when walking try using a cane (walking stick). Hold it in the hand on the opposite side of the body to the affected joint. This takes some pressure off the affected joint and helps to ease symptoms in some cases.
Diet - Vitamins, minerals, calcium should be obtained from natural dietary resources and
not by 'vitamin tablets/capsules' which can increase your risk of 'medicinal side-effects'.
Fruits, Salads, green vegetables/leaves, Sprouts -250 grammes
Curd/Yoghurt -250 grammes,
Lemon juice with little salt/sugar.
Water -5-6 lit per day or more, daily slow sustained yoga type physiotherapy exercises as given in website is essential for good health of bones and body.
Daily brisk/speed walking for 1 hour, getting enough vitamin D from your diet, sunlight will decrease your risk.
Cycling outdoors and non-gym outdoor exercises such as brisk walking, using stairs at home and office, walk at work bring overall improvement in health, well being besides controlling and curing many diseases such as Hypertension, diabetes, depression, cancer, osteoporosis, arthritis, muscular pains and joint pains.
Physical activity. Not exercising and being inactive or staying in bed for long periods can increase your risk.
Smoking. Smokers harm their blood circulation, damage all tissues in body by free radicals of smoke and absorb less calcium from their diets.
Medications. Some commonly used medicines can cause loss of bone mass. These include steroids used to control arthritis and asthma; some drugs used to treat seizures; some cancer drugs; and, too much thyroid hormone.
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