Shoulder pain is common and can affect your daily life. It can be caused by multiple diagnoses, so it’s important to get examined by a professional. It is important to seek help quickly, especially if your rotator cuff is injured, so that the injury does not get worse.
The rotator cuff is a group of four relatively small muscles that converge as tendons to form a cuff over the head of the humerus, or humerus. It helps raise and rotate the arm, shoulder, and stabilize the ball of the shoulder in the joint during normal daily activities.
What Causes Rotator Cuff Injuries?
Rotator cuff injuries are more common with age, with people over 40 at greater risk. The older you are, the more likely the rotator cuff injury is. Occupations that require repetitive overhead movements, such as construction workers, painters, joiners, and athletes such as baseball throwers, swimmers, and tennis players, are particularly prone to rotator cuff problems. Falls are another common way of injuring your shoulder.
“A common thread among the patients is that they fell six months ago, maybe on the ice in the
Dr. Douglas Stull
Winter, “said Dr. Douglass Stull, OrthoKansas orthopedic surgeon. “You injured your shoulder, but the pain was not enough to make you see a doctor.”
High cholesterol and smokers also increase the risk. Talk to your doctor about ways to lower your cholesterol, and if you smoke, it’s time to stop.
What types of rotator cuff injuries are there?
Dr. Stull said rotator cuff-related issues are the most common diagnosis for shoulder-related discomfort, be it acute or chronic. Acute injuries occur suddenly or as a result of a specific event, e.g. B. falling on an outstretched arm or lifting objects that are too heavy. A chronic injury is one that develops slowly over a period of time.
“I think the diagnosis occurs along a spectrum of diseases, from impingement – which means the tendons in the rotator cuff become trapped, move to partial thickness, then complete ruptures, and finally irreparable repairs,” he said.
Time to the doctor
Unless you have an acute shoulder injury, you may not be sure when to see a doctor about your pain. If you have any of these symptoms, it is time to speak to your doctor:
- Persistent shoulder pain that has persisted and has not gotten better over the course of a month
- Difficulty sleeping due to shoulder or upper arm pain
- Dramatic change in range of motion, e.g. B. Problems reaching seat belt or bra strap
“It is common for me to have a patient who fell six months ago and is now visiting me,” said Dr. Stull. “You may have fallen on the ice and injured your shoulder, but the discomfort didn’t bother you enough to call.”
Patients who contact OrthoKansas for evaluation and treatment can expect a thorough evaluation at their first appointment. Your doctor will take a thorough medical history, discuss any previous injuries, and ask about treatments that have already been performed. You may also need x-rays unless you recently took pictures.
When you need more advanced imaging, the musculoskeletal (MSK) trained radiologists from Professional Radiologic Services, a partner of LMH Health, are experts in the intricacies of orthopedic imaging.
“The beauty of MSK-trained radiologists is their connection to orthopedics,” said Dr. Stull. “Dr. Todd Oberzan and Dr. Thomas Grillot can look at a picture and we can communicate about it and get to the heart of the problem. You have the advantage of reading the exam notes and having access to all of the patient’s medical records.”
Do I have to have an operation?
Visiting an orthopedic surgeon to make a diagnosis doesn’t necessarily mean you will end up needing an operation. Depending on your medical history and examination, your doctor may recommend conservative treatment options before discussing surgical options.
Non-surgical treatments can include taking anti-inflammatory drugs like Advil or Aleve and physical therapy (PT). Injections are not recommended until the presence of a tear has been confirmed or ruled out, as treatment can later affect surgical results.
“Rotator cuff injuries are the number one reason I send someone out for physical therapy (PT). Seventy percent of chronic rotator cuff tears get better with therapy, ”said Dr. Stull. “If you are not facing an irreparable problem, we can treat you conservatively over a longer period of time.”
PT is often the first treatment and can be very effective. Dr. Stull sends many patients to Becky McClure, a physical therapist at LMH Health Therapy Services. Patients will undergo an initial examination that includes:
- Review of medical history, diagnostic tests, and previous shoulder problems
- Discuss normal activities at home, school, work, sports and hobbies
- Complete a physical exam, including posture check, observation of range of motion, and testing of muscle strength
“Once the evaluation is complete, we will discuss the results and work with the patient to develop a care plan to address the issues,” said McClure.
Subsequent therapy visits include training in avoiding aggravating activities and pain control. Patients perform exercises in the clinic and at home to maintain shoulder mobility and strength. For some patients, these exercises provide sufficient improvement in range of motion, neuromuscular control, strength, and endurance to regain full shoulder function.
“There is no one-size-fits-all exercise regimen that is suitable for everyone with a rotator cuff injury,” she said. “The physiotherapist will develop an individual exercise program for you based on your injury, evaluation and examination.”
Your PT progress will be monitored and modified throughout treatment until you can safely and comfortably return to your normal daily activities. People with rotator cuff weakness or a small tear can stay in rehab for two to four weeks, although some injuries can be persistent and take up to four to six months to heal.
Time for an operation
If medications and therapy don’t relieve your pain or improve your function, you may need surgery to repair the injury. If you’ve seen no improvement over a six to eight week period of consistent therapy, you may fall in the 30 percent of patients for whom surgery is a treatment option.
Surgical recommendation may also depend on the severity of the rotator cuff tear. Dr. Stull shared that most of the tears that require surgery are full-thickness cracks. This means that part of one of the four tendons that make up the rotator cuff is completely detached from the bone. It is not common for partial thickness tears or those that only reach a portion of the tendon to require surgery.
“Every patient has a different story and the indications for an operation are not always that simple. If you have an acute tear and are an active person, I recommend surgery almost 100 percent of the time, ”he said. “If you have a whole life ahead of you, you will generally be able to cope better with surgery than without.”
Patients undergoing surgery will have physical therapy to regain shoulder strength and mobility, usually for about four to six months. McClure said there are critical elements that will affect the length of your rehab.
“The size of the rotator cuff tear, the surgical repair itself, and the patient’s commitment to rehab all play a role in how long it will take,” she said.
Although by this point you are usually not released to full activity without restrictions, says Dr. Stull that recovery generally takes a year. It will likely take this long for your shoulder to feel normal again.
The LMH Health Therapy Services and OrthoKansas teams work closely to care for patients, with the clinicians, technology and facilities to provide care that is not just exceptional – it is among the best around. Call us and we will help you get moving again.