A rotator cuff is a group of muscles and tendons that surround the shoulder joint, keeping the head of the upper arm bone firmly within the shallow socket of the shoulder. A rotator cuff injury can cause a dull ache in the shoulder, which often worsens with the use of the arm away from the body.
Signs and symptoms
Pain in the shoulder which is:
- described as a dull ache deep in the shoulder
- Disturbing the sleep
- Restricting the movement of the shoulder. It will be difficult to comb the hair or reach behind the back
- accompanied by arm weakness
Causes
- A substantial injury to the shoulder
- Progressive degeneration
- Wear and tear of the tendon tissue due to repetitive overhead activity or heavy lifting over a prolonged period of time.
Pathophysiology
Degeneration of the rotator cuff tendon results from a variety of intrinsic factors including but not limited to age-related degeneration, inflammation, vascular changes, and oxidative stress. Among these elements, the key factor leading to rotator cuff weakness and degeneration is aging.
Rotator cuff injury starts from trauma. Macro-trauma causes an acute tear, which is seen generally a younger patient resulting in a complete tear. Micro-trauma causes tendon degeneration and with insufficient healing, leads to degenerative tears. Typically, acute tears happen in younger patients, and degenerative tears occur in older patients. However, a smaller amount of force is needed to cause a complete tear if there is sufficient tendon degeneration.
Diagnosis
- Physical examination
- X Ray
- MRI
- Ultrasound
Treatments
1.Conservative treatments — such as rest, ice and physical therapy
2.A steroid injection into shoulder joint
3.Physical therapy
4.Surgical procedures which include:
- Arthroscopic tendon repair
- Open tendon repair
- Tendon transfer
- Shoulder replacement
Prognosis
Most of the people with rotator cuff disease can manage their symptoms and return to activities with physical therapy exercises that improve flexibility and strength of the muscles surrounding the shoulder joint.
Complications
- Permanent loss of motion or weakness
- Progressive degeneration of the shoulder joint
- Frozen shoulder
Disease & Ayurveda
Khallwi/viswachi
Nidana
Dhaatukshaya (degeneration of tissues) – one reason being injury/trauma
Aavarana (obstruction to channels in the body)
Purvaaroopa
Not mentioned
Samprapti
Due to the causative factors Vaata gets vitiated and gets lodged in the arms, especially nerves & muscles, causing the signs & symptoms.
Lakshana
Restricted movements in the arm, especially shoulder joint
Pain in the shoulder
Divisions
Not mentioned
Prognosis
Saadhya when the disease is new
Krichrasadhya or yaapya when the disease is chronic
Chikithsa
Samana
Lepana with soolaharadravyas
Parisheka with warm soolahara-sothahara dravyas
Upanaha with Vaataharadravyas
Sirodhara, kateevasti, kateepichu with Vaatahara taila(once there is no aama)
Sodhana
Sneha (Abhyanga)
Sweda (Potalisweda)
Nasya
dhoomapaana
Vasti
Virechana
Raktamokshana
Daahakarma
Commonly used medicines
Maharasnadi kashayam
Yogarajaguggulu
Balaatailam
Guggulutiktakaghrutam
Brands available
AVS Kottakal
AVP Coimbatore
SNA Oushadhasala
Vaidyaratnam oushadhasala
Home remedies
Medical professionals suggest the following to ease pain & other disturbances in the shoulder & arm:
- Stop the activity that caused the pain.
- Stretch and massage the muscle.
- Hold the arm in the stretched position until the pain is relieved.
- Apply heat to muscles that are tight or tense.
- Use cold packs on tender muscles.
Diet
- To be avoided
Drink enough liquids. Ensure enough hydration.
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase kapha and cause obstruction in channels
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, sesame oil, fresh fruits & vegetables
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Protect yourself from very hot & cold climates.
Better to avoid exposure to excessive sunlight wind rain or dust.
Avoid lifting heavy weights and other vigorous physical activities.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Yoga
Vigorous exercises are not allowed in painful conditions.
Only stretching, moderate walking, and mild cardio exercises are advised. Also, specific yogacharya including bhujangaasana, salabhasana, vajrasana is recommended. Caution must be there to consider the range of movement and flexibility.
Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Yoga for rotator cuff injury
Bhujangasana
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4686437/
https://www.ncbi.nlm.nih.gov/books/NBK547664/
- https://doi.org/10.1016/S0736-0266(03)00116-5
The study was conducted to determine the relationship between rotator cuff (RC) tear and the orientation of the glenoid. Ninety‐six shoulders (94 patients) that underwent open RC repair were grouped according to the type of tear. They measured on MRI the acromio–glenoid angle (AG) and the supraspinatus fossa glenoid angle on the anterior–posterior (SGAP) and axial (SGAX) views. RC patients had a smaller AG angle and a larger SGAP angle compared to controls. It was also found a highly significant difference in glenoid version measured by SGAX between anterior cuff tears and posterior cuff tears. Furthermore, an association between RC tear and the orientation of the glenoid relative to the axis of the supraspinatus fossa was identified. It was concluded that greater retroversion is predictive of an anterior cuff injury and greater anteversion is predictive of a posterior cuff injury
These statements have not been evaluated by the Food and Drug Administration, United States. This product is not intended to diagnose, treat, cure or prevent any disease. Please consult your GP before the intake.
Writer:
Dr. Rajesh Nair, the co-founder and chief consultant of Ayurvedaforall.Com, is a graduate of prestigious Vaidyaratnam Ayurveda College (affiliated with the University of Calicut), Kerala, India. Additionally, he holds a Postgraduate Diploma in Yoga Therapy from Annamalai University.
Dr. Nair offers consultation at two busy clinics in and around Haripad, Alleppey, Kerala, the southern state famous worldwide for authentic ayurvedic treatment and physicians. While offering consultation on all aspects of ayurvedic treatments Dr. Nair has a special interest in Panchkarma, Yoga, and Massage.
Through Ayurvedaforall Dr. Nair offers online consultation to patients worldwide and has served hundreds of patients over the last 20 years. In addition to his Ayurvedic practice, he is the chief editor of ayurveda-amai.org, the online portal of Ayurveda Medical Association of India, and the state committee member of Ayurveda Medical Association of India.
Dr. Nair is a regular speaker at Ayurveda-related conferences and has visited Germany to propagate Ayurveda. You can write directly to him-
rajesh@ayurvedaforall.com
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