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In our last blog, we discussed what the rotator cuff was in terms of its structure as well as its function.  Now, we will discuss what injuries may occur to this region and proper treatment protocols.

Injuries at the rotator cuff can occur due to many reasons including repetitive movements overhead, lifting or pulling objects that are too heavy for your muscles to tolerate, bone spurs, or bracing yourself with your arm during a fall.  The results of an injury could be as simple as inflammation creating tendonitis.  This tendon inflammation results in a crowding of the small joint space thus making movement of the arm painful.  However, the injury could be more serious.  Repetitive overhead movements may create enough friction along the rotator cuff tendons to create tears.  These tears may be small resulting in a mild strain of the muscle; however, a larger tear could occur resulting in a complete rupture of the muscle or tendon.

Tendonitis and mild strains can often be remedied with the use of physical therapy in combination with anti-inflammatory medication without needing any invasive treatment.  Physical therapy may consist of specific exercises to maintain mobility and promote normal function, manual therapy to calm the irritated muscles, and modalities especially initially to calm pain and inflammation so that the individual can tolerate other treatments.  It is important to note that avoiding all movements at the shoulder due to irritation after a shoulder injury, could result in excessive tightening of the tissues around the shoulder or a “frozen shoulder.”  In other words, if you “baby” your shoulder too much rather than seeking effective treatment, you may end up with an even larger problem. 

With a tear of the rotator cuff, especially a large tear, surgical intervention may be required.  A tear could occur in only one of the rotator cuff muscles or in several of them with the supraspinatus muscle being the most commonly injured/torn of the four muscles. The biceps tendon may also sustain an injured with a rotator cuff tear and may need repaired as well.  If the tendon can be repaired then the surgeon will reattach the tendon. 

Following surgery, certain protocols must be followed in order to prevent any injury to the newly repaired tendons.  Different protocols exist depending on the severity of the tear.  With a rotator cuff repair, recovery time is variable, but it typically takes at least 6 months and can even take up to a year to regain full use of the operated shoulder.  In order to maintain the integrity of the newly repaired tendon(s), rehabilitation must begin slowly.  Rate of progression of therapy depends on the size of the tear and integrity of the repaired tendons.

The moral of the story is that recovery following a shoulder injury can be very time consuming, but if you do not follow the prescribed treatment plan, you can end up with even bigger problems. 

Resources:

http://www.mayoclinic.org/diseases-conditions/rotator-cuff-injury/basics/definition/con-20031421

http://www.southshorehospital.org/Workfiles/Medical_Services/Orthopedics/Rotator_Cuff_Repair.pdf

http://www.massgeneral.org/ortho/services/sports/rehab/Rotator%20cuff%20repair%20rehabilitation%20protocol.pdf

http://www.brighamandwomens.org/patients_visitors/pcs/rehabilitationservices/physical%20therapy%20standards%20of%20care%20and%20protocols/shoulder%20-%20arthroscopic%20rct%20repair%20protocol%20hybrid%20patient%20-%20therapist.pdf

http://www.orthoassociates.com/SP11B4/

http://ortho.templehealth.org/content/upload/AssetMgmt/Documents/PhysTher%20RTC_LOGO.pdf

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If you watch much in terms of sports or you have simply had a shoulder injury yourself, you have probably heard of the rotator cuff.  I have heard it called many things in the past including rotor cup or rotisserie cup; but, just to clarify, the actual name is rotator cuff.  There are several muscles that work together to form this structure situated at shoulder.

The rotator cuff consists of four muscles: the supraspinatus, infraspinatus, subscapularis, and teres minor.  Each of these muscles performs different duties, but they also work together to supply stability to the shoulder joint.  The shoulder joint is what is called a ball-and-socket joint, which is the same as the hip joint.  The hip joint, however, has a deeper socket and a lining called the acetabulum which helps to stabilize the head of the thigh bone (femur) in the socket of the hip bone (pelvis).  At the shoulder, the socket (glenoid) is shallower than the hip socket, so the arm bone (humerus) needs help from muscles around the joint to keep it stable.  That is where the rotator cuff comes in.

Each of the rotator cuff muscles attaches to both the shoulder blade (scapula) and the arm bone (humerus) to

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Read more: So, What is the Rotator Cuff?

physical therapyAs a physical therapist, I’ve heard patients come up with some pretty entertaining alternatives for the abbreviation PT, including pain and torture and even physical terrorists.  Now, these patients were, of course, speaking in jest; but, in truth, there can be elements of pain associated with rehab. 

Let me elaborate.  Pain is never something that a therapist strives to create, but it may be an unfortunate side effect of certain treatments.  We make sure that we are up front with our patients about what to expect in terms of discomfort or pain during various therapeutic techniques.  For example, when we are helping a patient gain full range of motion at his/her knee following a total knee replacement, there will likely be discomfort at the end of the range.  The same can be said for shoulder surgery.  The majority of shoulder surgeries can cause significant discomfort when attempting to gain full motion because of how small the region is and the amount of muscles and nerves that must pass in the often swollen area.  Another example of a treatment which may cause discomfort is electrical stimulation.  Certain forms of electrical stimulation are intended to create an electrical pulse that causes a muscle to contract and the intensity of the pulse may not be comfortable for all people.  As PTs, our goal is to help our patients regain function with as little discomfort as possible, but discomfort cannot always be avoided.

Two important things to understand are that not all pain is the same and no two people react to pain in exactly the same way.  Pain may be described as achy, sharp, dull, throbbing, pinching, burning, etc. depending on the cause of the pain.  Additionally, even if two people have the same surgery, one may have extreme pain and the other may have very little or no pain.  Depending on a person’s condition, a PT may choose to minimize focus on that patient’s pain, because focusing on it can actually increase awareness of pain and therefore the intensity of pain.  Other patients may need focus to be placed on pain because they could damage their tissues if they ignore their symptoms.

I have some patients that halt all activity at the slightest inclination of discomfort, while others are constantly trying to push themselves past their bodies’ limits.  Neither of these philosophies are necessarily good ones.  Pain is very subjective and often needs to be explained in terms of what is expected and what is abnormal.  Muscle soreness is a natural result of increased muscle activation.  When you perform new exercises, your muscles produce lactic acid.  This lactic acid is the root of the soreness or discomfort felt following new physical therapy mechanicsburgexercises.  If the soreness lasts for an extended period of time (ex. 3+ days), however, then your level of activity/exercise may have been too high and needs to be reduced.  Stretching is another activity that may cause discomfort that is misconceived as harmful pain.  When you are stretching you should feel pulling or even a slight burn in the muscle belly.  If this burn becomes excessively intense or turns into a sharper pain, then the stretch is likely being performed too far into the range and needs to be reduced.

Exercise should not be painful while you are performing it.  There are some exception with regard to various surgeries and chronic pain conditions where pain cannot be avoided during activity; but as a rule, exercise should not be painful.  The “no pain, no gain” philosophy is flawed.  Pain is your body’s natural defense mechanism.  If you ignore it, then you are likely causing damage to your muscles, ligament, nerve, or other structures in the body.  I cannot count the number of patients I have seen due to overuse injuries or who continued to exercise improperly despite pain.  Pain can be complicated and very subjective, so if you are not sure if your fitness routine is causing potential damage, then call your physical therapist for a consultation.

 

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Disclaimer:  The information in this medical library is intended for informational and educational purposes only and in no way should be taken to be the provision or practice of physical therapy, medical, or professional healthcare advice or services. The information should not be considered complete or exhaustive and should not be used for diagnostic or treatment purposes without first consulting with your physical therapist, physician or other healthcare provider. The owners of this website accept no responsibility for the misuse of information contained within this website.