What a sudden pain in the shoulder could mean

Tennis players with a hard serve are prone to getting rotator cuff injuries. — Filepic

I was swimming the freestyle one day, when I suddenly felt pain in my left shoulder. My shoulder continued to be painful for many days. It was difficult to sleep on my left side. I read that it might be a rotator cuff injury, but what is a rotator cuff?

Our rotator cuff is a large group of muscles and tendons that surround and protect our shoulder joint. There are four muscles altogether.

You see, our shoulder joint is made out of the head of our upper arm bone (humerus) inserted into a shallow cavity (the glenoid cavity) in our shoulder bone (scapula).

The rotator cuff muscles surround and encase the shoulder joint.

Every time you move your shoulder, you are using your rotator cuff.

How can my rotator cuff be injured?

Rotator cuff injuries actually increase as you get older.

They are quite common, and can range from mild to severe.

They are usually caused by overuse or sudden injury, like when you were swimming the freestyle.

You can also get it if you play tennis, like when you do an overhead serve, or if you row a boat/canoe vigorously or wrestle.

You can even tear your rotator cuff when you are involved in an accident or a fall, especially if you put out your arms to break the fall.

It can also occur as an occupational hazard.

For example, a construction worker (like a painter or carpenter) or a warehouse worker who has to reach overhead for materials can experience it, especially if they repeatedly perform the same task.

There is also a genetic component to rotator cuff injuries. You are more likely to get it if your parents have it.

Is it the muscles that are injured?

Rotator cuff injuries tend to fall into three different types of categories:

> Tendinitis

This is an injury and inflammation of the tendon, which is the tissue that attaches muscles to bones.

It is usually caused by repeated overuse of your rotator cuff, such as with painters, construction workers and tennis players who have a very hard serve.

> Bursitis

This is inflammation of the bursa, which are fluid-filled sacs that “cushion” your rotator cuff tendons and the underlying bone (Yes, think of them literally as cushions).

> Actual rotator cuff tears and strains

When the tendons that connect the muscles to the bones are overstretched suddenly or repeatedly (known as “wear and tear” type of injuries), they can be strained, or even tear.

The tear can be partial or complete.

How does a rotator cuff injury feel like?

Rotator cuff injuries feel like a dull ache in your shoulder that is quite deep.

The pain may also be felt in the outer side of your upper arm.

It can disturb your sleep, especially if you sleep on the side of the injury.

It can be difficult to raise your arm over your head and to do even simple things like combing your hair or scratching your back.

The pain worsens when you do things involving moving your arm away from your body. It may be associated with weakness in that arm.

The pain may also increase at night.

Not all rotator cuff injuries cause pain though.

For example, you may find yourself avoiding certain activities because you know or suspect they may cause you pain.

You may be unable to achieve the full range of your shoulder movements when you previously used to be able to.

You may have difficulty sleeping on the affected shoulder and may experience progressive weakness of that particular shoulder.

If you have been having these symptoms for longer than a week, you should see a doctor.

How is it treated?

You have to rest the arm, but not for too long or you may get a frozen shoulder.

The injury can actually get worse with time as it can progress to tendinitis.

That is why you should consult an orthopaedic surgeon as soon as possible.

Half of patients do not need surgery. Instead, you can:

• Use hot or cold ice packs to reduce any swelling you may have.
• Do exercises to restore your strength and range of movement.
• Discuss getting a steroid injection into the affected area with your doctor to reduce the inflammation.
• Wear a sling to minimise your movements and give time for the injury to heal.
• Take anti-inflammatory pain medications.

If these methods don’t work, then surgery is necessary to repair the rotator cuff.

Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health, computers and entertainment. For further information, email [e-mail]. The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.