Rotator Cuff Overview
The rotator cuff is made up of a set of four relatively small tendons in the shoulder called the supraspinatus, infraspinatus, subscapularis, and teres minor. Their job is to keep the ball of the shoulder joint in place. This task may sound relatively simple, but consider the enormous forces that sometimes pass through the shoulder, causing serious strain on these small muscles. If they fail, a combination of pain, weakness, and inefficient mechanics may prevent you from performing certain activities such as sports or your job.
The good news is that rotator cuff injuries can be prevented, and if caught early enough, can often be treated with physical therapy, medications, and injections. However, more serious rotator cuff injuries may require surgery. The shoulder specialists at Elite Sports Medicine + Orthopedics are experts at diagnosing and treating rotator cuff injuries and getting you back to normal activities as quickly as possible.
Stages of Rotator Cuff Injury
There are three stages of rotator cuff injury. The first stage is tendinitis, a simple inflammation of the rotator cuff, which can be painful but is relatively simple to treat. The second stage is tendinosis, in which the tendons of the rotator cuff start to degenerate. The third stage is a tear of the rotator cuff.
Tendinitis and tendinosis can usually be treated with physical therapy, medications, and injections, with a high success rate. Very small tears, or partial tears, may also be treated conservatively, but generally with larger tears, or complete tears, your shoulder specialist may recommend surgery. Shoulder surgery is followed by intensive physical therapy to regain shoulder motion, rebuild the rotator cuff strength, and help prevent a future injury.
Signs of a Rotator Cuff Tear or Other Injury
The best way to successfully treat a rotator cuff injury is early recognition. This can mean the difference between conservative treatment and surgery, and the difference between returning soon to the game or job and an extended absence while recovering.
Early warning signs of a rotator cuff tear include:
- Shoulder pain when getting dressed, particularly when you are putting on or taking off a shirt
- Shoulder pain when reaching behind the body, such as reaching into the back seat of a car
- Pain in the shoulder when attempting overhead activities
If any of these signs persist for more than a couple of weeks, you should get your shoulder evaluated promptly
- Signs of a more advanced rotator cuff injury include:
- Weakness or a sense of instability in the shoulder
- Shoulder pain when you are lying on your back and resting, or pain that continues through the night
- Constant, intractable pain in the shoulder
If you have any of these symptoms, you should request evaluation from an orthopedic shoulder specialist immediately. People over 50 years of age who experience any of these symptoms are considered high risk for rotator cuff tear.
Rotator Cuff Tear Treatment
Every rotator cuff injury has its own unique cause, particular damage, and best path to recovery. After examination in the clinic, the majority of people will require an MRI to confirm a diagnosis. Once the diagnosis has been made, we can create a personalized treatment program that may include physical therapy, injections, medications, or surgery. The in-house physical therapists at Elite are in tune with rotator cuff injuries and post op care, and work closely with the providers to develop a personalized treatment plan.
Sometimes, conservative treatment fails to improve your pain and the only option is surgery. The surgeons at Elite Sports Medicine use the most advanced surgical options available today. Most of the time, a rotator cuff tear can be treated arthroscopically, which means that the surgery is minimally invasive. The surgeon uses a small camera and small instruments to surgically repair the rotator cuff without the need for a large incision or overnight stay in the hospital.
Occasionally, rotator cuff tears are so large or have persisted for such a long period of time that they are no longer repairable arthroscopically. When this is the case, more invasive surgery may be needed to remedy the pain. This surgery may include replacing the shoulder joint.
Rotator Cuff Tear Prevention
Keeping the rotator cuff muscles strong and flexible is the best way to prevent a rotator cuff injury. Major League baseball pitchers make rotator cuff training one of their top priorities in the off season because they know they will have longer, more successful careers if they do. Any qualified coach, athletic trainer, or physical therapist, should be able to guide you in developing a rotator cuff training program. Anyone at risk for rotator cuff injury should strongly consider starting and sticking to such training. The trainers and therapists at MPower Performance Institute are available and willing to help set you up with such a program.
In conclusion, the rotator cuff, although small, plays a large part in the function of your shoulder. If an injury is ignored, it can lead to the need for extensive surgery and can potentially cause a lifetime of pain.
Do not ignore your shoulder pain. If you believe you may have suffered a rotator cuff tear or similar injury, please schedule an appointment with one of our experienced orthopedic surgeons in Nashville, TN and Franklin, TN.
Will Gailbreath, ACNP-BC