Rotator Cuff Tears

Rotator cuff tears are one of the most common injuries of the shoulder. The anatomy of the shoulder is a ball-and-socket joint made up of three bones: the humerus (upper arm bone), scapula (shoulder blade), and clavicle (collarbone). The rotator cuff is comprised of 4 muscles and keeps the arm in the shoulder socket and provides stability.
 

There are two main types of tears:

1. Partial Tear
2. Full Thickness or Complete Tear

Tears are primarily caused by acute injury or overuse. Acute tears are the result of injury, such as falling on an outstretched arm or lifting a heavy object. With acute injuries, it is not uncommon to see other injuries present as well. 

Tears caused by overuse or degeneration occur over time and can be the result of the following:

•  Repetitive motion of the shoulder (i.e.  lifting, throwing, overhead work)
• Blood supply – as we age, the blood supply to the rotator cuff tendon decreases leaving the rotator cuff more susceptible to injury
• Shoulder impingement

Symptoms of a rotator cuff tear include:

• Pain at rest and/or at night
• Pain with lifting
• Weakness
• Cracking in the shoulder

Treatment of rotator cuff tears depends on the severity of the tear. Partial tears can often be treated non-surgically with physical therapy, rest, ice and anti-inflammatory medication. For full thickness tears, surgical intervention is recommended. Surgery is performed arthroscopically through a small incision in the shoulder. 

In surgical repair, bio-absorbable anchors are used to reattach the rotator cuff to its anatomically correct position. In our practice, we use a “double row” technique to reinforce the repair, reduce the risk of a repeat tear and enable healing. 

Some physicians recommend moving the shoulder immediately following surgery, however, we disagree. We recommend immobilizing the shoulder for approximately 3-4 weeks post-op. The Center for Special Surgery agrees and published an article on how immobilization following rotator cuff surgery leads to better healing. For a full overview, please see our previous post from August 2012. 

Rotator cuff tears are common and treatable. Early intervention in the case of degenerative tears can help prevent the need for surgical intervention. Advocare Orthopedic and Sports Medicine is here to help. Call to schedule your appointment: 973-300-1553 or follow us at facebook.com/johnvitolomd.

Common Injuries of the Rotator Cuff

The rotator cuff is a group of muscles and tendons in the shoulder. The rotator cuff allows for stability and movement of the shoulder. This piece of the anatomy is commonly injured as a result of overuse or acute injury.

There are five main conditions that involve the rotator cuff:

1. Rotator cuff tear
2. Rotator cuff tendonitis
3. Rotator cuff impingement
4. Frozen Shoulder
5. Subacromial Bursitis

Rotator Cuff Tears

Rotator cuff tears cause pain and weakness in the shoulder, making everyday activities difficult. People most at risk for a rotator cuff tear are those over 40 and those athletes or workers who engage in repetitive overhead and lifting activities. Treatment varies depending on the size/severity of the tear and the age/activity level of the patient. 

Rotator Cuff Tendonitis

Rotator cuff tendonitis occurs when the rotator cuff tendons become aggravated or inflamed. This causes pain in the shoulder. The pain is typically located in the front of the shoulder and sometimes extends to the upper arm. Tendonitis often occurs in conjunction with bursitis. The pain may make sleeping uncomfortable and sometimes a ‘clicking’ sound is heard when raising the arm.

Rotator Cuff Impingement

Rotator cuff impingement occurs when the rotator cuff is being pinched by the bones of the shoulder causing pain. Symptoms of impingement may develop gradually, with the pain becoming worse over time. When diagnosed early, impingement can generally be treated conservatively with physical therapy, ice, activity modification and anti-inflammatories.

Subacromial Bursitis

Subacromial Bursitis occurs when the bursa (the fluid filled sac located between the acromion and rotator cuff) becomes inflamed. The bursa acts as a cushion between the bones and tendons. When inflamed, pain is felt. Bursitis can typically be treated conservatively. 

Frozen Shoulder

Frozen shoulder or adhesive capsulitis causes pain and stiffness in the shoulder that becomes worse over time. Individuals between 40 and 60 years of age are more prone to this condition. Frozen shoulder can be debilitating, but is treated non-surgically in 90% of cases. 

It is not uncommon for multiple conditions to be present at the same time. If you experience shoulder pain, it is important to see a physician as soon as possible. In many of these conditions, early treatment can prevent larger issues in the future. Left untreated, less serious conditions can develop into more complicated issues that require surgical intervention and longer recovery times.

What is the Rotator Cuff?

The rotator cuff is a part of the shoulder that is necessary for stability and movement. The rotator cuff allows for lifting and rotation of the arm.  According to the American Academy of Orthopedic Surgeons, the rotator cuff sent approximately 2 million people to the doctor in 2008.[i]

Anatomy

The shoulder is a ball-and-socket joint made up of bones, muscles and tendons. The rotator cuff keeps the arm in the shoulder socket and is comprised of 4 muscles and tendons.

The three bones of the shoulder:

1. Humerus (upper arm bone)
2. Scapula (shoulder blade)
3. Clavicle (collarbone). T

The 4 muscles of the rotator cuff are:

1. Teres Minor
2.        Infraspinatus
3.        Supraspinatus
4.        Subscapularis.

The muscles of the rotator cuff attach to the scapula. Each muscle also has a tendon that attaches to the humerus. The tendons form a cuff around the shoulder joint, which provides stability for the shoulder joint and allows movement. Another important part of the shoulder is the bursa. The bursa is a sac that lies between the acromion (the upper bone in the shoulder) and the rotator cuff. The bursa allows the tendons to move easily.

Common injuries of the rotator cuff are tendonitis, bursitis and tears. Causes of injury include age, overuse or acute injury (fall on outstretched hand). Many conditions/injuries of the shoulder can be treated non-surgically, but more serious tears are typically treated with arthroscopic surgery.

In upcoming posts, we will discuss these injuries and conditions in more detail. If you feel that you have injured your rotator cuff, it is important to consult a physician. Advocare Orthopedic and Sports Medicine, the office of John Vitolo, MD is available to treat any orthopedic issues.

 

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[i] http://orthoinfo.aaos.org

Baseball Season: Protect your Shoulder

Spring is in the air!  It is baseball season; time to get out and enjoy this classic American sport.  Many kids and adults play the game and probably give little thought to the impact playing can have on the shoulder.  It is important to be aware of the potential injuries that can occur so that a small strain does not evolve into a serious problem. 

Bursitis, rotator cuff weakness and rotator cuff tears are all possible complications from the constant throwing, batting and diving that are involved in the wonderful sport of baseball.   What are injuries should you be aware of and how are they caused? 

Rotator Cuff Weakness:  Rotator cuff weakness can be caused by a constant throwing motion.  Weakness occurs when the rotator cuff tendons become inflamed and may get pinched under the shoulder blade. 

Tendonitis/Bursitis:  Tendonitis occurs when the rotator cuff tendons and/or the bursa become irritated and inflamed.  Symptoms include extreme pain or weakness, especially when the shoulder is in motion.   These conditions often occur in conjunction with each other, but pain associated with Bursitis tends to be located just under the joint capsule. 

Rotator Cuff Tear:  Here we have the ‘worst case scenario’.   Rotator cuff tears occur when the tendon is ripped off the bone.  Symptoms include:  limited motion, decreased shoulder strength and aching and weakness when you lift your arm above your head.  Surgery is often required to fix a rotator cuff tear. 

The big question is:  how do you avoid these injuries and stay in the game? 

One great way to prevent injuries of the shoulder is Strength Training.  Around the shoulder blade (also called the scapula) are a series of muscles that together with the rotator cuff, allow a dynamic, fluid motion seen with throwing. Many athletes perform exercises that strengthen the large muscles of the shoulder, such as the pectoralis major and deltoid muscle, but ignore the rotator cuff and smaller muscles surrounding the shoulder blade.  Failure to strengthen these smaller muscles, called the parascapular muscles and rotator cuff muscles, can result in pain while throwing, and issues with shoulder function.   

Examples of rotator cuff exercises are resisted external and internal rotation exercises of the shoulder, reverse flies and seated rows (look for future posts for more details on these exercises).  All of these exercises should be performed with an emphasis on squeezing your shoulder blades together while doing each repetition.  These muscles are small in relation to other muscles in the body and do not require a significant amount of resistance.  A few pounds of weight or a light resistance band is usually adequate for strengthening. 



As a reminder, prior to performing any of these exercises it is important to see your orthopedic surgeon if you are unable to lift your arm, or if you are unable to perform these exercises due to pain or discomfort.

Prevention of these injuries is often possible.  In addition to the strength training mentioned above, here are some additional tips from STOP Sports Injuries (www.stopsportsinjuries.org):

• Warm up & stretch -  it is important to  stretch out  the shoulder and start with a few “softer” throws.
• Play various positions - this is especially important for the younger athletes.  Switching positions and using different body parts/muscles is an important component to preventing injury.  
•  DON’T play through the pain!  If pain persists, see a doctor. 
• Take time to rest.  If you are a pitcher, try to take a day or two off between games. 
• Concentrate on control, form and accuracy when throwing or pitching. 

If you suspect you or your child has a shoulder injury, we are here to help.  Skyview Orthopedic Associates is an excellent resource.  Our staff is focused on individualized, state of the art patient care and is led by John Vitolo, MD.  Dr. Vitolo specializes in injuries and disorders on the shoulder and knee.  He is board certified in orthopedic surgery and sports medicine.  Dr. Vitolo was also recently named to the NJ Top Doc list.   For additional information, visit www.skyvieworthopedic.com or call 973-300-1553.