Rotator Cuff Symptoms Sleep Disorders - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes the condition of rotator cuff tears and how it affects sleeping - sleeping disorders.
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Rotator Cuff Symptoms Sleep Disorders – Everything You Need To Know

The rotator cuff is a group of four muscles that include the Supraspinatus, Infraspinatus, Teres Minor, and Subscapularis. Each muscle has its own function. These rotator cuff muscles are commonly injured or affected. Rotator cuff tears are a common source of shoulder pain. Tears of the rotator cuff may involve a single tendon or multiple tendons. A tear may be partial or complete. The patient may present with a painful, weak shoulder. The patient will also complain of a gradual onset of pain that is increased by overhead activity. The pain is localized over the deltoid muscle area. The patient may have loss of active range of motion of the shoulder. The passive range of motion of the shoulder is usually intact. The patient will have weakness of abduction and will be unable to elevate the arm above 90 degrees. If you inject the shoulder with lidocaine, there will be no improvement if the shoulder movement after the injection (pseudoparalysis).
Always check the range of motion of both shoulders to compare the shoulder movement actively and passively. It is the active range of motion the affected side will be limited. 90% of patients with a rotator cuff tear complain of night pain (shoulder pain at night). Night pain can mean that nonoperative treatment of the rotator tear may not work. It also means that patients with rotator cuff disease will have sleeping disorders. If the rotator cuff tear is traumatic, the pain can be acute and associated with sudden shoulder weakness. Sleeping disturbance is a common complaint in patients with rotator cuff tears. The patient with rotator cuff tear may not be able to sleep from the pain and this usually makes the patient want to go for surgery.
A small tear is usually up to 1 cm, a medium tear is 1-3 cm, a large tear is 3-5 cm, and a massive tear is greater than 5 cm. The rotator cuff tears can also be partial thickness or full thickness. Research found that the status of the rotator cuff does not correlate with the worst pain. For example, if you have a full thickness tear or a massive tear, it does not correlate with the worst sleep quality. So, the status of the rotator cuff did not correlate with increasing symptoms of shoulder pain or with the worst sleep quality. If the patient has inflammation of the rotator such as with the impingement or if the patient has a partial thickness or full thickness tear, all the patients have the same complaint of shoulder pain, night pain and sleep disturbance.
Worsening of the shoulder pain and sleep quality may not be clearly associated with the severity of rotator cuff disease. Some people think that there is another source of pain, and that the shoulder pain and lack of sleep is not due to the rotator cuff tear because there are a lot of patients who have rotator cuff tears and are symptomatic. The older population has a lot of rotator cuff tears and the majority of them are asymptomatic (they don’t complain about it). Full thickness and partial thickness rotator cuff tears are seen on the MRI or ultrasound in asymptomatic individuals. Its prevalence is over 55% in individuals over the age of 60 years old. The frequency of these tears increases with age.
Patients usually sleep in the following positions:
• Supine
• Prone
• Lateral Decubitus
• Supine with the shoulders abducted
Sleeping in a supine position has a lower subacromial pressure than the other positions. Increased subacromial pressure will decrease the blood flow to the rotator cuff and increase the severity of the disease. Clearly the sleeping position may affect the sleeping quality in patients with rotator cuff disease and that is why the patient may not be able to sleep on the affected shoulder due to worsening pain that is causing sleep disruption.
Is it an increased pressure in the shoulder that causes the pian and the sleeping disorder?
There are several factors that correlate with the worst sleep quality:
• Female
• Depression
• Obesity
• Diabetes
• Low back pain
• Cervical spine involvement