Pain Conditions

Pain Conditions

Randall Pain Management provides the most comprehensive treatment for chronic and acute pain. Through selective diagnostic tests we aim to find the source of pain and treat it using a multimodal approach. Advanced interventional techniques will decrease the reliance on medications alone.

Use this page to learn about the various pain conditions we specialize in treating. Use the link at the bottom of each section to learn more about the condition.

DEGENERATIVE DISC DISEASE

This condition is a weakening of one or more vertebral discs, which normally act as a cushion between the vertebrae. This condition can develop as a natural part of the aging process, but it may also result from injury to the back.

  • Disc Wall Tears

    Degenerative disc disease typically begins when small tears appear in the disc wall, called the annulus. These tears can cause pain.

  • Disc Wall Heals

    When the tears heal, creating scar tissue that is not as strong as the original disc wall. If the back is repeatedly injured, the process of tearing and scarring may continue, weakening the disc wall.

  • Disc Center Weakens

    Over time, the nucleus (or center) of the disc becomes damaged and loses some of its water content. This center is called the pulposus, and its water content is needed to keep the disc functioning as a shock absorber for the spine.

  • Nucleus Collapses

    Unable to act as a cushion, the nucleus collapses. The vertebrae above and below this damaged disc slide closer together. This improper alignment causes the facet joints – the areas where the vertebral bones touch – to twist into an unnatural position.

  • Bone Spurs Form

    In time, this awkward positioning of the vertebrae may create bone spurs. If these spurs grow into the spinal canal, they may pinch the spinal cord and nerves (a condition called spinal stenosis). The site of the injury may be painful.

Symptoms

Some people experience pain, numbness or tingling in the legs. Strong pain tends to come and go. Bending, twisting and sitting may make the pain worse. Lying down relieves pressure on the spine.

FACET JOINT SYNDROME

This condition is a deterioration of the facet joints, which help stabilize the spine and limit excessive motion. The facet joints are lined with cartilage and are surrounded by a lubricating capsule that enables the vertebrae to bend and twist.

  • Joint Damage

    Facet joint syndrome occurs when the facet joints become stressed and damaged. This damage can occur from everyday wear and tear, injury to the back or neck or because of degeneration of an intervertebral disc.

  • Cartilage Loss

    The cartilage that covers the stressed facet joints gradually wears away. The joints become swollen and stiff. The vertebral bones rub directly against each other, which can lead to the growth of bone spurs along the edges of the facet joints.

  • Symptoms (cervical)

    Pain from facet joint syndrome differs depending on which region of the spine is damaged. If the cervical, or upper spine is affected, pain may be felt in the neck, shoulders, and upper or middle back. The person may also experience headaches.

  • Symptoms (lumbar)

    If the lumbar, or lower spine, is affected pain may be felt in the lower back, buttocks and back of the thigh.

Treatment

Facet joint syndrome is first treated conservatively with rest, ice, heat, anti-inflammatory medications, and physical therapy. In addition, facet joint blocks may be administered not only to diagnose facet joint pain but also to treat it. If non-surgical methods fail to relieve pain, a facet rhizotomy or bone fusion may be performed.

DISC HERNIATION

A herniated disc is a common injury that can affect any part of the spine. A herniated disc can cause severe pain and other problems in the arms or legs.

  • Causes

    Herniated discs commonly result from age-related weakening of the spinal discs. This is called disc degeneration, and it can occur gradually over many years as a result of normal wear and tear on the spine. A herniated disc can also result from a traumatic injury, or from lifting a heavy object improperly.

  • Symptoms

    Symptoms of a herniated disc vary depending on the location of the disc and the severity of the rupture. Some herniated discs cause no symptoms, and a person with this type of injury may not realize the disc is damaged. But a herniated disc can also cause severe pain, numbness or tingling, and weakness. Most herniated discs occur in the lower back, where they can cause symptoms in the buttocks, legs and feet. Herniated discs also occur in the neck, where they can cause symptoms in the shoulders, arms and hands.

Treatment

Treatment options for herniated disc depend on the location and severity of the injury. A herniated disc may be treated with pain-relieving medications, muscle relaxers and corticosteroid injections. A person with a herniated disc may benefit from physical therapy. If these methods are not effective, the disc may need to be treated with a surgical procedure.v

ANNULAR TEARS

This condition is an irritation or compression of one or more nerve roots in the lumbar spine. Because these nerves travel to the hips, buttocks, legs and feet, an injury in the lumbar spine can cause symptoms in these areas. Sciatica may result from a variety of problems with the bones and tissues of the lumbar spinal column.

POST-LAMINECTOMY SYNDROME

This condition, also called “failed back syndrome,” is a type of chronic pain. It can develop in some people after spine surgery.

  • Causes

    This pain most often develops after a laminectomy procedure. This is the removal of bone at the rear of your vertebrae. The procedure is done to relieve pressure on your spinal nerves. But after a laminectomy, bone or soft tissue may still press on these nerves. Scar tissue may form. And spinal joints may be irritated and inflamed. Pain from any of these issues may be called “post-laminectomy syndrome”.

  • Symptoms

    Symptoms may include pain in your back at the site of your surgery. The pain may also radiate down to your buttock and leg. This pain may feel sharp, or it may feel dull and achy.

Treatment

Treatment depends on the cause and the severity of your pain. It may include medications, injections or physical therapy. You may benefit from electrical nerve stimulation or other techniques. If these are not helpful, surgery may relieve your pain.

SPINAL STENOSIS

The spinal column contains open spaces that create passageways for the spinal cord and the spinal nerves. Spinal stenosis is a narrowing of (or an intrusion into) these openings. This can cause a compression of the nerves. Spinal stenosis most commonly affects the cervical and lumbar regions of the spine.

  • Anatomy

    Each vertebra has a large opening at the rear called the spinal canal. In the cervical and thoracic regions of the spine, the spinal cord travels through this space. In the lumbar region of the spine, this opening contains a bundle of nerve roots. Openings called foramina branch away from the spinal canal. These spaces provide pathways for the nerve roots that travel from the spine to other parts of the body.

  • Stenosis

    In a spine with stenosis, one or more of these openings are narrowed. The spinal nerves can become compressed against the vertebral bone. This can interfere with nerve function. It can cause pain in the spine or in other parts of the body.

  • Causes

    Stenosis is commonly caused by an excess growth of bone around the spinal nerves. This excess bone growth often results from osteoarthritis. Stenosis can also result from a dislocation or a fracture of the vertebral bone. Stenosis can be caused by soft tissue intruding into the spine’s open spaces. Herniated discs, tumors, and thickened spinal ligaments can press against the spinal nerves. And in some cases, a person is born with a small spinal canal that does not provide enough room for the spinal nerves.

Symptoms

Symptoms of spinal stenosis can vary depending on the location and severity of the problem. Spinal stenosis can cause pain, weakness, numbness and tingling in the arms and legs. Spinal stenosis in the lower back commonly causes sciatica, a sensation of burning pain that can travel through the buttocks and down the legs. Spinal stenosis can also cause problems with control of the bladder and bowels.

SPONDYLOLISTHESIS

This condition occurs when a lumbar vertebra slips out of place. It slides forward, distorting the shape of your spine. This may compress the nerves in the spinal canal. The nerves that exit the foramen (open spaces on the sides of your vertebrae) may also be compressed. These compressed nerves can cause pain and other problems.

  • Common Causes

    Spondylolisthesis has a variety of causes. In children, it is often due to a birth defect in that area of the spine. Some people develop this condition because of an overuse injury called “spondylolysis.” This is a stress fracture of the vertebral bone. In adults, arthritis and the loss of disc elasticity that results from aging are the most common causes of spondylolisthesis.

  • Other Causes

    Less commonly, spondylolisthesis can result from a sudden injury that leads to a broken vertebra. Diseases or tumors that weaken the spine can also result in spondylolisthesis.

  • Symptoms

    Symptoms vary from person to person. Many people who have this condition have no symptoms at all. If you do have symptoms, you may experience pain in your lower back. You may have hamstring spasms. Pain may spread down your leg to your foot. You may also have foot numbness and tingling.

Treatment

Treatment options depend on the severity of your condition. You may benefit from rest. Medications may relieve your pain. A back brace may also help. And, you may benefit from physical therapy. If those methods are not successful, you may benefit from a surgical procedure to reduce nerve compression or to stabilize your spine.

Trigeminal Nerve Pain

This chronic condition is caused by a misfiring of the trigeminal nerve. An attack causes brief episodes of extreme, shooting pain.

RADICULOPATHY

Radicular pain is often secondary to compression or inflammation of a spinal nerve. When the pain radiates down the back of the leg to the calf or foot, it would in lay terms be described as sciatica. This type of pain is often deep and steady, and can usually be reproduced with certain activities and positions, such as sitting or walking.The pain usually follows the involved dermatome in the leg - the area of distribution of the leg covered by the specific nerve. When a nerve at the L4-5 or L5-S1 level is affected (bottom two levels), this dermatome is usually the sciatic nerve, which runs down the back of each leg to the foot.

Radicular pain may also be accompanied by numbness and tingling, muscle weakness and loss of specific reflexes. When actual nerve dysfunction is noted (prior noted symptoms), this is termed “radiculopathy”.

  • Area of Pain Distribution:

    Radicular pain radiates into the lower extremity (thigh, calf, and occasionally the foot) directly along the course of a specific spinal nerve root. The most common symptom of radicular pain is sciatica (pain that radiates along the sciatic nerve - down the back of the thigh and calf into the foot). Sciatica is one of the most common forms of pain caused by compression of a spinal nerve in the low back. It often will be caused by compression of the lower spinal nerve roots (L5 and S1).

    With this condition, the leg pain is typically much worse than the low back pain, and the specific areas of the leg and/or foot that are affected depends on which nerve in the low back is affected. Compression of higher lumbar nerve roots such as L2, L3 and L4 can cause radicular pain into the front of the thigh and the shin.

  • Diagnosis of Lumbar Radiculopathy:

    A radiculopathy is caused by compression, inflammation and/or injury to a spinal nerve root in the low back. Causes of this type of pain, in the order of prevalence, include:

    Herniated disc with nerve compression - by far the most common cause of radiculopathy
    Foraminal stenosis (narrowing of the hole through which the spinal nerve exits due to bone spurs or arthritis) – more common in elderly adults
    Diabetes
    Nerve root injuries
    Scar tissue from previous spinal surgery that is affecting the nerve root
    Sciatica, the term commonly used to describe radicular pain along the sciatic nerve, describes where the pain is felt but is not an actual diagnosis. The clinical diagnosis is usually arrived at through a combination of the patient’s history (including a description of the pain) and a physical exam. Imaging studies (MRI, CT-myelogram) are used to confirm the diagnosis and will typically show the impingement on the nerve root.

Treatment of Lumbar Radiculopathy:

It is usually recommended that a course of nonsurgical treatment (such as physical therapy, medications, and selective spinal injections, among others) should be conducted for six to eight weeks. If nonsurgical treatment does not alleviate the pain, decompressive surgery, such as laminectomy and/or discectomy/microdiscectomy, may be recommended. This type of surgery typically provides relief of radicular pain/leg pain for 85% to 90% of patients. For patients with severe leg pain or other serious symptoms such as progressive muscle weakness, this type of surgery may be recommended prior to six weeks of non-surgical treatment. Back surgery for relief of radicular pain (leg pain) is much more reliable than the same surgery for relief of low back pain.

The decision to proceed with surgery is based on severity of leg pain and/or the presence of significant muscle weakness. It is important to note that if definitive nerve compression cannot be documented on an MRI or CT-myelogram, then back surgery is ill advised and unlikely to be successful.

SYMPATHETIC NERVE PAIN (CRPS) COMPLEX REGIONAL PAIN SYNDROME

Complex regional pain syndrome (CRPS), also called reflex sympathetic dystrophy syndrome, is a chronic pain condition in which high levels of nerve impulses are sent to an affected site. Experts believe that CRPS occurs as a result of dysfunction in the central or peripheral nervous systems.

CRPS is most common in people ages 20-35. The syndrome also can occur in children; it affects women more often than men.

There is no cure for CRPS.

  • What Causes Complex Regional Pain Syndrome?

    CRPS most likely does not have a single cause; rather, it results from multiple causes that produce similar symptoms. Some theories suggest that pain receptors in the affected part of the body become responsive to catecholamines, a group of nervous system messengers. In cases of injury-related CRPS, the syndrome may be caused by a triggering of the immune response, which may lead to the inflammatory symptoms of redness, warmth, and swelling in the affected area. For this reason, it is believed that CRPS may represent a disruption of the healing process.

  • What Are the Symptoms of Complex Regional Pain Syndrome?

    The symptoms of CRPS vary in their severity and length. One symptom of CRPS is continuous, intense pain that gets worse rather than better over time. If CRPS occurs after an injury, it may seem out of proportion to the severity of the injury. Even in cases involving an injury only to a finger or toe, pain can spread to include the entire arm or leg. In some cases, pain can even travel to the opposite extremity. Other symptoms of CRPS include:
    "Burning" pain
    Swelling and stiffness in affected joints
    Motor disability, with decreased ability to move the affected body part
    Changes in nail and hair growth pattern; there may be rapid hair growth or no hair growth.
    Skin changes; CRPS can involve changes in skin temperature -- skin on one extremity can feel warmer or cooler compared to the opposite extremity. Skin color may become blotchy, pale, purple or red. The texture of skin also can change, becoming shiny and thin. People with CRPS may have skin that sometimes is excessively sweaty.
    CRPS may be heightened by emotional stress.

  • How Is Complex Regional Pain Syndrome Diagnosed?

    There is no specific diagnostic test for CRPS, but some testing can rule out other conditions. Triple-phase bone scans can be used to identify changes in the bone and in blood circulation. Some health care providers may apply a stimulus (for example, heat, touch, cold) to determine whether there is pain in a specific area.

    Making a firm diagnosis of CRPS may be difficult early in the course of the disorder when symptoms are few or mild. CRPS is diagnosed primarily through observation of the following symptoms:

    The presence of an initial injury
    A higher-than-expected amount of pain from an injury
    A change in appearance of an affected area
    No other cause of pain or altered appearance

How Is Complex Regional Pain Syndrome Treated?

Because there is no cure for CRPS, the goal of treatment is to relieve painful symptoms associated with the disorder. Therapies used include psychotherapy, physical therapy, and drug treatment, such as topical analgesics, narcotics, corticosteroids, osteoporosismedication, antidepressants, osteoporosis medicines, and antiseizure drugs.

Other treatments include:

Sympathetic nerve blocks: These blocks, which are done in a variety of ways, can provide significant pain relief for some people. One kind of block involves placing an anesthetic next to the spine to directly block the sympathetic nerves.
Surgical sympathectomy: This controversial technique destroys the nerves involved in CRPS. Some experts believe it has a favorable outcome, while others feel it makes CRPS worse. The technique should be considered only for people whose pain is dramatically but temporarily relieved by selective sympathetic blocks.
Intrathecal drug pumps: Pumps and implanted catheters are used to send pain-relieving medication into the spinal fluid.
Spinal cord stimulation: This technique, in which electrodes are placed next to the spinal cord, offers relief for many people with the condition.

OSTEOARTHRITIS KNEE, HIP, SHOULDER

Osteoarthritis (also known as OA) is a common joint disease that most often affects middle-age to elderly people. It is commonly referred to as "wear and tear" of the joints, but we now know that OA is a disease of the entire joint, involving the cartilage, joint lining, ligaments, and bone. Although it is more common in older people, it is not really accurate to say that the joints are just “wearing out.” It is characterized by breakdown of the cartilage (the tissue that cushions the ends of the bones between joints), bony changes of the joints, deterioration of tendons and ligaments, and various degrees of inflammation of the joint lining (called the synovium).

This arthritis tends to occur in the hand joints, spine, hips, knees, and great toes. The lifetime risk of developing OA of the knee is about 46 percent, and the lifetime risk of developing OA of the hip is 25 percent, according to the Johnston County Osteoarthritis Project, a long-term study from the University of North Carolina and sponsored by the Centers for Disease Control and Prevention (often called the CDC) and the National Institutes of Health.

OA is a top cause of disability in older people. The goal of osteoarthritis treatment is to reduce pain and improve function. There is no cure for the disease, but some treatments attempt to slow disease progression.

  • What is osteoarthritis?

    OA is a frequently slowly progressive joint disease typically seen in middle-aged to elderly people. In osteoarthritis, the cartilage between the bones in the joint breaks down. This causes the affected bones to slowly get bigger. The joint cartilage often breaks down because of mechanical stress or biochemical changes within the body, causing the bone underneath to fail. OA can occur together with other types of arthritis, such as gout or rheumatoid arthritis.

    OA tends to affect commonly used joints such as the hands and spine, and the weight-bearing joints such as the hips and knees. Symptoms include:

    Joint pain and stiffness
    Knobby swelling at the joint
    Cracking or grinding noise with joint movement
    Decreased function of the joint

  • How do you treat osteoarthritis?

    There is no proven treatment yet that can reverse joint damage from OA. The goal of osteoarthritis treatment is to reduce pain and improve function of the affected joints. Most often, this is possible with a mixture of physical measures and drug therapy and, sometimes, surgery.

    Physical measures: Weight loss and exercise are useful in OA. Excess weight puts stress on your knee joints and hips and low back. For every 10 pounds of weight you lose over 10 years, you can reduce the chance of developing knee OA by up to 50 percent. Exercise can improve your muscle strength, decrease joint pain and stiffness, and lower the chance of disability due to OA. Also helpful are support (“assistive”) devices, such as orthotics or a walking cane, that help you do daily activities. Heat or cold therapy can help relieve OA symptoms for a short time.

    Certain alternative treatments such as spa (hot tub), massage, and chiropractic manipulation can help relieve pain for a short time. They can be costly, though, and require repeated treatments. Also, the long-term benefits of these alternative (sometimes called complementary or integrative) medicine treatments are unproven but are under study.

    Drug therapy: Forms of drug therapy include topical, oral (by mouth) and injections (shots). You apply topical drugs directly on the skin over the affected joints. These medicines include capsaicin cream, lidocaine and diclofenac gel. Oral pain relievers such as acetaminophen are common first treatments. So are nonsteroidal anti-inflammatory drugs (often called NSAIDs), which decrease swelling and pain.

    In 2010, the government (FDA) approved the use of duloxetine (Cymbalta) for chronic (long-term) musculoskeletal pain including from OA. This oral drug is not new. It also is in use for other health concerns, such as mood disorders, nerve pain and fibromyalgia.

    Patients with more serious pain may need stronger medications, such as prescription narcotics.

    Joint injections with corticosteroids (sometimes called cortisone shots) or with a form of lubricant called hyaluronic acid can give months of pain relief from OA. This lubricant is given in the knee, and these shots may help delay the need for a knee replacement by a few years in some patients.

    Surgery: Surgical treatment becomes an option for severe cases. This includes when the joint has serious damage, or when medical treatment fails to relieve pain and you have major loss of function. Surgery may involve arthroscopy, repair of the joint done through small incisions (cuts). If the joint damage cannot be repaired, you may need a joint replacement.

    Supplements: Many over-the-counter nutrition supplements have been used for osteoarthritis treatment. Most lack good research data to support their effectiveness and safety. Among the most widely used are calcium, vitamin D and omega-3 fatty acids. To ensure safety and avoid drug interactions, consult your doctor or pharmacist before using any of these supplements. This is especially true when you are combining these supplements with prescribed drugs.

  • How is osteoarthritis diagnosed?

    Rheumatologists are doctors who are experts in diagnosing and treating arthritis and other diseases of the joints, muscles and bones. You may also need to see other health care providers, for instance, physical or occupational therapists and orthopedic doctors. Most often doctors detect OA based on the typical symptoms (described earlier) and on results of the physical exam. In some cases, X-rays or other imaging tests may be useful to tell the extent of disease or to help rule out other joint problems.

Living with osteoarthritis

There is no cure for OA, but you can manage how it affects your lifestyle. Some tips include:

Properly position and support your neck and back while sitting or sleeping.
Adjust furniture, such as raising a chair or toilet seat.
Avoid repeated motions of the joint, especially frequent bending.
Lose weight if you are overweight or obese, which can reduce pain and slow progression of OA.
Exercise each day.
Use adaptive devices that will help you do daily activities.
You might want to work with a physical therapist or occupational therapist to learn the best exercises and to choose arthritis assistive devices.

CARPAL TUNNEL SYNDROME

Carpal tunnel syndrome reflects a clinical diagnosis that involves one of the three main nerves in the arm. The median nerve passes through the carpal tunnel, which is located right here. The carpal tunnel itself houses the flexor tendons of the hand as well the fingers, the thumb, and the median nerve. Typically a patient will present with complaints of numbness and tingling, having to shake their hands in the morning. They might have complaints of numbness or tingling after typing at the keyboard or doing any repetitive motion that puts increased pressure on the wrist in either this direction or that direction.

Although the median nerve innervates the first 3.5 fingers of the hand, the patient usually does not have numbness and tingling just in that distribution. A lot of the times, they can have paresthesia within the whole hand and that sensation can vary from a frank falling asleep, to an itchiness, to feeling a need to stretch the hand, to do some type of motion, to shake the hand. A variety of those symptoms can occur.

  • What Causes Carpal Tunnel Syndrome?

    There are about 5-6 main causes of carpal tunnel syndrome. Heredity plays an important role. Some people are born with congenitally small carpal tunnels. Any associated medical conditions, including rheumatoid arthritis, diabetes, and systemic conditions that may also increase the amount of fluid in the carpal tunnel may increase the likelihood of developing carpal tunnel syndrome.

  • What are the Symptoms of Carpal Tunnel Syndrome?

    Patients often can present with difficulty buttoning their shirt, sometimes difficulty holding a pencil, quite often they’ll complain of dropping things inadvertently. When the symptoms are very bad, they’ll be able to see a visible atrophy of the muscles of their thumb.

  • How is Carpal Tunnel Syndrome Diagnosed?

    In a physical examination for carpal tunnel syndrome, we’ll do a regular neurologic exam, testing the strength of all the muscles in their upper extremities, their sensation, and their reflexes. For carpal tunnel syndrome, there are a number of provocative tests that put pressure on the median nerve, which when a person does have carpal tunnel syndrome will be positive. Also during the physical examination, this is a chance to rule out when the numbness and tingling is not coming from carpal tunnel syndrome but also from other nerves, most often the neck.

    In terms of diagnosis, the most objective way to diagnose carpal tunnel syndrome is to do an EMG and nerve conduction study, which provide a way to measure the degree of carpal tunnel syndrome (to classify as mild, moderate, severe) and also to rule out anything associated, number one, compressed nerves, or if there’s an associated and irritated nerve that’s coming from the neck.

Evaluating for Carpal Tunnel Syndrome

The easiest way to look at carpal tunnel syndrome is to imagine that your hands are like light bulbs. When the light bulbs are going off in your house, that example can be related to the sensation of numbness and tingling in your hands. Sometimes that light bulb goes out when there’s something wrong with the light bulb itself, but sometimes it can go out because there’s something wrong with the power supply. So when evaluating for carpal tunnel syndrome, you want to see if it’s just the light bulbs, where the median nerves are specifically irritated, or if there is anything also going on with the power supply. The EMG and nerve conduction studies are good for telling that.

TENDINITIS

Tendinitis is inflammation, irritation, and swelling of a tendon. This is the fibrous structure that joins muscle to bone. In many cases, tendinosis (tendon degeneration) is also present.

  • Causes

    Tendinitis can occur as a result of injury or overuse. It also can occur with aging as the tendon loses elasticity. Body-wide (systemic) diseases, such as rheumatoid arthritis or diabetes, can also lead to tendinitis.

    Tendinitis can occur in any tendon. Commonly affected sites include the:

    Elbow
    Heel (Achilles tendinitis)
    Shoulder
    Wrist

  • Symptoms

    Pain and tenderness along a tendon, usually near a joint
    Pain at night
    Pain that is worse with movement or activity.

Treatment

The goal of treatment is to relieve pain and reduce inflammation.

The doctor will recommend resting the affected tendon to help it recover. This may be done using a splint or a removable brace. Applying heat or cold to the affected area can help.

Nonsteroidal anti-inflammatory medications (NSAIDs), such as aspirin or ibuprofen, can also reduce both pain and inflammation. Steroid injections into the tendon sheath can also be very useful for controlling pain.

The doctor may also suggest physical therapy to stretch and strengthen the muscle and tendon. This can restore the tendon's ability to function properly, improve healing, and prevent future injury.

In rare cases, surgery is needed to remove the inflamed tissue from around the tendon.

ROTATOR CUFF SYNDROME

The rotator cuff is a group of muscles and tendons that surround the shoulder joint, keeping the head of your 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 when you try to sleep on the involved side.

Rotator cuff injuries occur most often in people who repeatedly perform overhead motions in their jobs or sports. Examples include painters, carpenters, and people who play baseball or tennis. The risk of rotator cuff injury also increases with age.

Many people recover from rotator cuff disease with physical therapy exercises that improve flexibility and strength of the muscles surrounding the shoulder joint.

Sometimes, rotator cuff tears may occur as a result of a single injury. In those circumstances, medical care should be provided as soon as possible. Extensive rotator cuff tears may require surgical repair, transfer of alternative tendons or joint replacement.

  • Causes

    Rotator cuff disease may be the result of either a substantial injury to the shoulder or to progressive degeneration or wear and tear of the tendon tissue. Repetitive overhead activity, heavy lifting over a prolonged period of time, and the development of bone spurs in the bones around the shoulder may irritate or damage the tendon.

  • Symptoms:

    The pain associated with a rotator cuff injury may:

    Be described as a dull ache deep in the shoulder
    Disturb sleep, particularly if you lie on the affected shoulder
    Make it difficult to comb your hair or reach behind your back
    Be accompanied by arm weakness

  • Risk factors

    The following factors may increase your risk of having a rotator cuff injury:

    Age. As you get older, your risk of a rotator cuff injury increases. Rotator cuff tears are most common in people older than 40.
    Certain sports. Athletes who regularly use repetitive arm motions, such as baseball pitchers, archers and tennis players, have a greater risk of having a rotator cuff injury.
    Construction jobs. Occupations such as carpentry or house painting require repetitive arm motions, often overhead, that can damage the rotator cuff over time.
    Family history. There may be a genetic component involved with rotator cuff injuries as they appear to occur more commonly in certain families.