You’ve been playing a little too much pickleball or bowling, holding babies or toddlers too long or carrying heavy groceries into the house. Now you have some aches and pains in your shoulder and it’s hard to sleep at night. A part of your shoulder called your rotator cuff might be to blame and, no, this injury doesn’t just happen to professional athletes.
“The rotator cuff is a collection of four deep muscles in the shoulder that all originate from the shoulder blade and their tendons reach out and surround the ball at the shoulder joint,” explains Robert T. Sullivan, MD, orthopaedic surgeon, with Roper St. Francis Physician Partners. “They play a critical role in shoulder stability and shoulder range-of-motion.”
Dr. Sullivan said that rotator cuff-related problems are either from trauma to the joint or lifelong wear-and-tear related to repetitive use. “The older we get the more prevalent rotator cuff disease or disorders occur,” he said.
According to the American Academy of Orthopaedic Surgeons (AAOS), that significant portion is actually 2 million people in the United States who visit their doctors every year because of a rotator cuff problem. “The overwhelming majority of rotator cuff issues are usually folks in their 60s and older and, anecdotally, it’s equal women versus men.”
How do you know if you have an issue with your rotator cuff? “Common symptoms include difficulty sleeping on the injured side or shoulder pain when reaching outward or overhead,” said Dr. Sullivan. “Rotator cuff pain is typically located on the outside area of the shoulder and will often radiate down the arm but not necessarily below the elbow.”
The AAOS adds other symptoms including weakness when lifting or rotating your arm or a grating or crackling sensation when you move your shoulder in certain positions.
Dr. Sullivan describes that other shoulder issues you may have, such as bursitis or an impingement, might also be directly related to a rotator cuff injury. “Impingement of a tendon is most often a result of a deficient rotator cuff, whether the rotator cuff is torn or weak”.
The good news is that most rotator cuff injuries are conservatively treated. “I start by telling my patients to try to avoid offending activities, such as heavy overhead lifting or retrieving things with the arm fully stretched out,” explains Dr. Sullivan. “Keep your arm close to your body to avoid putting extreme stress on those rotator cuff tendons and make sure that your shoulder doesn't get stiff.”
A stretching regimen is vital to improving shoulder rotation. “Treatment is centered around retaining full shoulder range-of-motion and strengthening the intact or residual rotator cuff and retaining shoulder range-of-motion is critical,” said Dr. Sullivan, who also explains that if you’re stretching out your shoulder, be careful. “The shoulder often responds to overstretching with increased stiffness and inflammation. I want your rehab to be no more painful than if you were stretching the back of your legs.”
Stretches should be sustained or prolonged where you're holding the stretch for a minimum of 30 seconds. Prior to stretching, he recommends taking a towel and submerging it in hot water, wringing it out and putting it on your shoulder. “Let your shoulder warm for 20 to 30 minutes and then get into your stretching routine. Tissues are much more pliable when they're warm.”
Treatment may also include anti-inflammatories as well as a steroid injection. “I am not a big fan of immediately going to a corticosteroid for rotator-cuff-related problems, because although the steroid can significantly reduce pain and inflammation, it comes at a cost where the steroid can create other problems, including further degeneration or weakening of the tendon,” said Dr. Sullivan. “If there's surgery in the near future there is data that shows an increased risk of an infection or a decreased healing rate after surgery if the surgery is done within two to three months of the most recent injection. So, we use injections judiciously and we don't like to do repetitive injections.”
Rotator cuff surgery is a final resort after a patient with a partial tear has not shown improvement after therapy and depending on the grade of the tendon tear. “There is a point of no return in rotator cuff degeneration because if it's a long-standing tear, we can begin to see changes in the muscle itself in a process that's called fatty infiltration,” he said. “If that process goes on to involve greater than 50% of the muscle, it's almost a non-repairable tendon at that point.”
If you have shoulder pain and would like to make an appointment with one of our doctors please call (843) 402-CARE or visit: rsfh.com/findadoctor