Spotting Problems and Treatment Options
Your rotator cuff is a group of four tendons and muscles that surround, stabilize and move the shoulder joint. It helps you lift and rotate your arm, while keeping your upper arm bone, stable within the socket of your shoulder.
Injuries to the rotator cuff are fairly common. If can happen from a sudden fall on the arm to simple wear and tear. People who do lots of repetitive motions are especially prone to this type of injury. It's often seen in carpenters, tennis coaches, swimmers, gymnasts and baseball players.
The odds of experiencing rotator cuff injuries increase as we age, especially for people over 40. These are the three types of injury you should be aware of.
In rotator cuff tendinosis, there is a structural change in the tendon at the microscopic level. Bit by bit the tendon gets worn down through repeated stressors. Everything's still connected, but what's there is thin and weak.
In a partial tear, the soft tissue is damaged and things are starting to disconnect, but the tendon hasn't yet completely torn away.
In a complete or full-thickness tear, the tendon separates from the top of the upper arm bone (the humeral head).
Success rates for treating the problem are much higher if you catch it early. Here are some of the typical warning signs of rotator cuff problems.
You experience a dull pain or ache in your shoulder anytime you try and use your arms or you apply pressure to the shoulder area.
Pain when reaching up or extending your arms above your head. Painters are likely to feel this one.
Pain when reaching back, such as bringing your arm back when you're about to throw a ball.
Pain in the shoulder that lasts longer than the soreness from a hard workout. Anything constant for more than four or five days can indicate a problem.
A therapist starts by evaluating your posture, then suggesting changes to help reduce pain. Then they analyze how you do things, like repetitive motions at work, so they can teach you healthier ways to move. That includes relearning how to properly carry and lift heavy objects. You'll also likely be given ideas of how to lay in bed without pinching or hurting your shoulder during sleep. Finally they'll teach you exercises to strengthen the muscles holding your shoulders together.
Here are a few of the more common exercises that have been shown to help.
FLEXION: Lie down with your head flat, eyes looking up, legs bent and feet flat. Hold a stick in both hands, palms facing each other, shoulder-width apart. Move your arms up over your head, keep your elbows straight and stretch. Hold with your arms up for 5 seconds, then return to the starting position. Repeat 10 times.
EXTENSION: Stand straight up, with your head level and eyes looking forward. Hold a stick in both hands, palms up, shoulder-width apart. Move the stick away from your back. Once you reach the point where you can't move it any further away, hold for 5 seconds, then relax and return to the starting position. Repeat 10 times.
EXTERNAL ROTATION: Lie flat on your back, with your upper arms resting on the floor and the injured elbow (right arm) at your side, bent at a 90-degree angle. Hold a stick in both hands, palms up, shoulder-width apart. Use the arm that is not injured (left arm) to push the injured arm out away from your body. The elbow of your injured arm should stay at your side. Hold the stretch for 5 seconds then return to the starting position. Repeat 10 times.
Scapular Range of Motion
Stand straight up, with your head level and eyes looking forward. Shrug your shoulder up and hold for 5 seconds. Then squeeze your shoulder blades back and together and hold for 5 more seconds. Finally, pull your shoulder blades down as if you're trying to put them in your back pocket. Relax. Then repeat 10 times.
EXTERNAL ROTATION: Stand just outside a doorway with your elbow bent at a 90-degree angle. Press the BACK of your hand against the door frame, then attempt to press your hand INTO the door frame for 3 seconds. Relax and repeat 10 times.
INTERNAL ROTATION: Stand just outside a doorway with your elbow bent at a 90-degree angle. Press the PALM of your hand against the door frame, then attempt to press your hand INTO the door frame for 3 seconds. Relax and repeat 10 times.
Tubing/Band Exercise for External Rotation
Stand straight up, with your head level and your eyes looking forward. Bend the elbow that's on the injured side to 90 degrees and keep your hand pointed straight out. (Put a small roll under the arm you're exercising to keep it hanging down straight.)
Grasp tubing or a band that's connected to something stable at waist level. Keep your elbow at your side and rotate your arm outward, away from your waist. Keep your elbow bent at 90 degrees and your forearm parallel to the floor. Return to starting position and repeat 10 times.
Stand straight up, with your head level and your eyes looking forward. Let your arms drop to your sides and your thumbs point to the floor. Lift your arms up and out from your sides, keeping your elbows straight (don't bend them). Once your arms are at shoulder level, stop and hold for 3 seconds, then relax and slowly let your arms back down. You can add weight to this exercise, but only small amounts to increase strength. Repeat 10 times.
If your orthopedic doctor recommends surgery, there are two options to consider. Conventional surgery is quite good at stitching things together, but it doesn't do much to improve the underlying tendon tissue. The recovery period can last several months and if activities are too quickly resumed, the injury can happen again.
A new alternative is something called “bioinductive implant.” It's about the size of a postage stamp and made from type I bovine collagen. The surgeon makes a cut and inserts the implant. That implant then helps induce the formation of new tendinous tissue, resulting in a thicker and potentially stronger tendon.
The claimed benefits are accelerated rehabilitation, which can let you resume normal activities sooner after surgery. It's also the only procedure that is explicitly designed to help the underlying tissue, not simply the tear itself.
The clinical trial information is still coming in, but results from the first two years (of very limited trials) show healing rates from 89% to 96%. The patch has been used successfully and safely in “tear sizes ranging from partial thickness tears to massive tears, as well as primary and revision repair settings.” There have been no adverse clinical reactions observed in the first three years of use.
For many who have avoided surgery in the past, this option provides a promising new alternative. HOWEVER, this procedure is still EXTREMELY new and long-term studies have yet to come in. As of 8/28/2019 it has also not been used on a large volume of people and more clinical trials should be done. Until more significant studies are available, you should consider this an experimental procedure.
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