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 Baseball and Softball Injuries: Glenohumeral Internal Rotation Disorder (GIRD)

Shoulder injuries are common in baseball and other sports involving overhead activites. Prevention is possible and the first step in prevention is knowledge. In this post, we will examine a common shoulder condition of the glenohumeral joint called Glenohumeral Internal Rotation Disorder or GIRD. 

The genohumeral joint is what most people think of as the “ball and socket” of the shoulder. Clinically, it is the joint that connects the humerus and scapula. This important joint is what allows the arm to move in a circular motion. 

Baseball pitchers rely on the Glenohumeral Joint for throwing. The strain that pitchers put on this joint by repetitively throwing can lead to GIRD. GIRD is an injury that develops over time as a result of overuse and is not typically an acute injury. 

GIRD is defined as a 20⁰or greater loss of internal rotation of the throwing shoulder. Other symptoms include: 

• Vague pain in the shoulder with overhead pain
• Decrease in throwing performance (control and velocity)
• Occasionally, a decrease in motion
• Increased range of external rotation and decreased internal rotation vs. non-dominant shoulder

Normally, GIRD is treated using non-invasive methods. Surgery is not normally required to treat this condition.  A common treatment plan could include the following:

•  Rest from throwing for a period of 3-6 months
• Physical Therapy that includes various stretches for the posterior and inferior capsules

In rare cases where rest and physical therapy does not work, arthroscopic surgery may be performed to restore range of motion. However, most cases of GIRD can be treated non-surgically. If you suspect you suffer from GIRD or another shoulder injury, make an appointment to see Dr. Vitolo or your orthopedic surgeon.

Preventing Overuse Injuries in Young Athletes this Baseball Season

Baseball season is here! Young athletes are ready to start training. While the old adage “practice makes perfect” is true, our youth need guidance in order to prevent injury.

Overuse injuries in school aged athletes are on the rise. The incidence of shoulder and elbow injuries among youth baseball and softball players is five times greater than it was in the year 2000.[i] Many of these baseball injuries are preventable.

In recent years, Little League Baseball has released guidelines and enforced regulations to help prevent injury in young athletes (see charts below). The league has put limits on pitch counts during games and also enforced required rest periods. All the guidelines are based on the age of the athlete.

While the guidelines from Little League Baseball are important, there are additional steps that can be taken at practices and off the field. Here are some tips:

1.  Always warm up – stretch, jog and begin with some easy, gradual throwing
2. Try different positions – different positions require the use of various muscle groups
3. REST – don’t play year round and allow rest between games
4. Focus on your form, accuracy and control
5. If you have shoulder or elbow pain, do not pitch
6. Talk to your parents and coaches about any pain – do not play through the pain!

Getting kids involved in sports at an early age is a great idea, but it is important to remember an injury can end their baseball career too soon. By following the suggestions outlined here, injury can be avoided and a lifelong love of baseball and activity can be built!

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[i] http://www.stopsportsinjuries.org/media/statistics.aspx

Maximum Pitch Counts and Required Rest Periods courtesy of Little League Baseball