The rotator cuff is a group of muscles and tendons in the shoulder that help in movement while making it strong and stable. Due to wear and tear, the rotator cuff weakens and this may lead to related conditions like impingement, tendonitis and rotator cuff tears. Everyone can suffer these ailments not only while playing sports or any intense physical activity but also your normal, everyday chores in and around the home, while commuting, or at the office. Basically any direct trauma to the shoulders and arms, repetitive motion, or making an awkward move that strains the shoulder, can cause rotator cuff dysfunction.
The elderly is more prone to rotator cuff injuries because studies have shown that the muscles and tendons thin, fray, or tear as part of the aging process. The shoulder joint is especially vulnerable since we use it all the time. The prevalence of rotator cuff tears is 21 to 27 percent on average among the elderly, and as much as 31 percent in the 70-79 year-old group and 51 percent in the 80-89 year-old age bracket. While many are asymptomatic especially during the younger years, symptoms worsen as they grow older. Yet studies believe that rotator cuff tears are underdiagnosed and undertreated among seniors. Many just put up with it and attribute it “old age” without knowing that they still can benefit from proper care even at home.
Symptoms of a rotator cuff tear may include any or all of the following: painful deltoid muscle near the shoulder especially while rotating or extending the arm, a popping or clicking felt or heard during a physical examination, weakness, guarding and pain when raising or rotating the shoulder or arm. Plain x-rays may appear normal but an MRI scan can show a partial or full tear.
When diagnosed with a rotator cuff tear or tendonitis, many physicians and therapists adopt a conservative approach especially when dealing with elderly patients. It is believed that conservative care is effective for seniors compared to surgery considering the latter’s risks and the fact that blood supply is diminished in old age and therefore surgery may not be successful. Conservative treatment may include: rest, ice/heat application, NSAIDS (anti-inflammatories), steroid injections, exercises and physical therapy. Surgery may be an option if these conservative measures fail. Again, the outcomes of surgical interventions are mixed.
A rotator cuff tear or injury suffered by a patient is challenging because it compromises their functional ability and independence on a daily basis. This is especially true among the elderly because they have to deal with other chronic conditions and a rotator cuff tear just compounds their everyday troubles. They have difficulty performing basic tasks such as combing their hair, dressing, raising their arms to reach something, lifting objects, and other simple movements. Worse, many also complain of a dull ache during the night that can disrupt sleep and/or a stabbing pain during the day which affects daily activities.
Home care interventions as a part of a conservative treatment plan devised by a physical therapist, orthopedist or a primary care physician can go a long way in dealing with a rotator cuff tear. Personal care assistants can make it easier for seniors who suffer from these injuries to go about their normal routine around the home. A simple yet prudent example is for a PCA to make sure the risk for falls is minimal. That means making sure rugs are secure, wires are tucked on the side, there is proper lighting along stairs and hallways, etc. A PCA will physically assist the elderly who has a weakened shoulder in getting in and out of the bed or wheelchair. Falls are often a major cause of rotator cuff tears among the elderly who are already prone to falls and subsequent shoulder injuries.
A home care assistant can also assist in simple tasks such as slipping an arm into a sleeve while dressing, applying ice and heat in the affected area, giving pain medications, and providing assistance in lifting and reaching for objects. Adequate rest periods are important but the affected shoulder must maintain its flexibility because immobility will only make symptoms worse. So, a PCA can assist the elderly in performing gentle range-of-motion exercises of the shoulder joint as prescribed by a physician or PT. A simple method is to lift canned goods or similar objects and make repeated rotations of the shoulder and arms, stopping when any pain is felt. A personal caregiver who is given proper instructions can help in performing simple exercises such as this to strengthen the rotator cuff.
Symptoms of a rotator cuff tear often linger even with early conservative treatment and advanced surgical methods. Shoulder pain and weakness may not be completely eliminated and loss of function of the shoulders impact the person’s quality of life. It may not be as drastic a change as compared to what far more grave illnesses can cause to the person, but it affects his or her independence and functional ability nevertheless.
A shoulder ailment such as a rotator cuff tear can be chronic and your family member who is at an advanced age and dealing with a host of other conditions may not adjust well. Thankfully, we have resources available to help them. Hire another family member as a PCA, tap an independent caregiver for non-medical services, or avail of home care agencies with experience in taking care of clients who have suffered from a rotator cuff tear. Contact a Minnesota Home Care Agency to learn more about these services.