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.