18 year old Tennis player flew in from Guatemala today, presents with complaint of shoulder pain. Patient states that for the past year her shoulder has been aching and interfering with her game. The onset of pain has been gradual and she states she hears sounds as she raises her shoulder. She states there is no pain as long as she does not move the shoulder. Her past medical history is otherwise unremarkable, she takes no medications. She does not smoke or drink alcohol. She is brought here by her mom who was treated at the center several years ago.
Discussion: This is the youngest patient I have seen with rotator cuff problem however Rotator cuff tears are becoming more and more prevalent in young adults and a cause of pain and disability. The rotator cuff is made up of four muscles and their tendons. Together they form a "cuff" over the Humerus head (medical lingo: the upper arm bone). The four muscles are called supraspinatus, infraspinatus, subscapularis, and teres minor . The rotator cuff job is to lift and rotate the arm and to hold the ball of the shoulder within the joint. Most of damages occur at the level of supraspinatus. Some of the common symptoms are:
Pain upon lifting of the arm or lowering the arm from a fully raised position
Weakness upon lifting or rotating the arm.
Crepitus or crackling sensation (the sound that the above patient experiences) upon moving the shoulder in certain directions.
In advanced cases atrophy or thinning of the muscles could be noted on the exam.