How can you identify a rotator cuff injury. What are the common symptoms of rotator cuff problems. When should you seek medical attention for shoulder pain. What treatment options are available for rotator cuff injuries. How can you prevent rotator cuff damage.

Understanding the Rotator Cuff: Anatomy and Function

The rotator cuff is a crucial component of the shoulder joint, playing a vital role in arm movement and stability. It consists of four muscles and their associated tendons that work together to enable smooth shoulder function. To fully comprehend rotator cuff injuries, it’s essential to understand its structure and purpose.

The Four Muscles of the Rotator Cuff

• Supraspinatus
• Infraspinatus
• Subscapularis
• Teres minor

These muscles originate from the shoulder blade (scapula) and attach to the upper arm bone (humerus) via tendons. Their primary functions include stabilizing the shoulder joint and facilitating various arm movements, particularly rotation and elevation.

Common Symptoms of Rotator Cuff Injuries

Recognizing the signs of a rotator cuff injury is crucial for early intervention and proper treatment. While symptoms may vary depending on the type and severity of the injury, there are several common indicators to watch for.

Key Symptoms to Look Out For

• Shoulder weakness
• Pain when lifting or rotating the arm
• Difficulty sleeping on the affected side
• Popping or clicking sensations during arm movement
• Reduced range of motion

Do shoulder injuries always cause immediate pain? Not necessarily. In some cases, particularly with degenerative tears, symptoms may develop gradually over time. It’s important to pay attention to any persistent discomfort or limitations in shoulder function.

Types of Rotator Cuff Injuries: From Tendonitis to Tears

Rotator cuff injuries can manifest in various forms, ranging from mild inflammation to complete tendon tears. Understanding the different types of injuries can help in identifying the problem and seeking appropriate treatment.

Rotator Cuff Tendonitis

Tendonitis occurs when the tendons of the rotator cuff become irritated and inflamed. This condition often develops gradually due to repetitive overhead movements or prolonged pressure on the shoulder, such as sleeping on the same side every night.

Impingement and Bursitis

Impingement syndrome involves the compression of the rotator cuff tendons between the acromion (part of the shoulder blade) and the humerus. This can lead to bursitis, an inflammation of the bursa sac that cushions the rotator cuff tendons.

Rotator Cuff Tears

Tears in the rotator cuff can be partial or full-thickness. Partial tears involve damage to the tendon without complete detachment, while full-thickness tears result in a complete separation of the tendon from the bone.

Classification of Rotator Cuff Tears

1. Degenerative tears: Caused by wear and tear over time, more common in older adults
2. Traumatic tears: Result from sudden injury or fall, more prevalent in younger individuals

Diagnosing Rotator Cuff Injuries: The Role of Medical Professionals

Accurate diagnosis of rotator cuff injuries requires the expertise of medical professionals, particularly sports medicine physicians or orthopedic specialists. These experts employ various techniques to assess the nature and extent of shoulder problems.

Diagnostic Methods

• Physical examination
• Range of motion tests
• Strength assessments
• Imaging studies (X-rays, MRI, ultrasound)

Why is a comprehensive evaluation necessary? It helps differentiate rotator cuff injuries from other shoulder conditions, such as cervical spine issues or biceps tendon problems, ensuring appropriate treatment.

Treatment Options for Rotator Cuff Injuries

The approach to treating rotator cuff injuries depends on several factors, including the type and severity of the injury, the patient’s age, activity level, and overall health. Treatment options range from conservative management to surgical intervention.

Non-Surgical Treatment

• Rest and activity modification
• Ice or heat therapy
• Anti-inflammatory medications
• Physical therapy and exercises
• Corticosteroid injections

Can most rotator cuff injuries be treated without surgery? Yes, many rotator cuff problems respond well to conservative treatment, especially when addressed early.

Surgical Intervention

In cases of severe or persistent rotator cuff injuries, surgery may be necessary. Surgical options include:

• Arthroscopic tendon repair
• Open tendon repair
• Tendon transfer
• Shoulder replacement (in extreme cases)

Preventing Rotator Cuff Injuries: Proactive Measures

While not all rotator cuff injuries can be prevented, there are steps you can take to reduce your risk and maintain shoulder health.

Preventive Strategies

• Proper warm-up before physical activities
• Strengthening exercises for shoulder muscles
• Maintaining good posture
• Avoiding repetitive overhead movements when possible
• Using proper technique during sports and work activities

How often should you perform shoulder exercises? Incorporating shoulder-strengthening exercises into your routine 2-3 times per week can help maintain rotator cuff health.

Recovery and Rehabilitation After Rotator Cuff Treatment

Recovering from a rotator cuff injury, whether treated surgically or non-surgically, requires patience and dedication. A well-structured rehabilitation program is crucial for regaining shoulder strength and function.

Key Components of Rotator Cuff Rehabilitation

• Gradual range of motion exercises
• Progressive strengthening of shoulder muscles
• Scapular stabilization exercises
• Functional training for daily activities and sports

What is the typical timeline for rotator cuff recovery? Recovery timelines vary depending on the severity of the injury and the treatment approach. Non-surgical rehabilitation may take 6-12 weeks, while recovery from surgery can extend to several months.

Long-Term Outlook and Management of Rotator Cuff Health

Maintaining long-term rotator cuff health requires ongoing attention and care, especially for those who have experienced previous injuries or are at higher risk due to age or occupation.

Strategies for Long-Term Shoulder Health

• Regular shoulder-strengthening exercises
• Proper ergonomics at work and home
• Avoiding overuse and repetitive strain
• Prompt attention to any new shoulder symptoms

Is it possible to prevent future rotator cuff injuries after recovering from one? While there’s no guarantee, maintaining shoulder strength and flexibility, along with proper body mechanics, can significantly reduce the risk of future injuries.

Understanding rotator cuff injuries, their symptoms, and treatment options is crucial for anyone experiencing shoulder pain or weakness. By recognizing the signs early and seeking appropriate medical care, you can prevent minor issues from progressing to more serious conditions. Remember, shoulder health is an ongoing process that requires attention, care, and proactive measures to maintain optimal function and prevent injuries.

How to Tell When You’ve Torn or Injured Your Rotator Cuff

There’s a fine line between normal wear and tear and an actual tear of your rotator cuff.

Posted
by Featured Provider Christopher Kim on Friday, March 26, 2021

Raise your hand if you’ve experienced shoulder pain.

If your hand isn’t stretched high above your head, there’s a decent chance you have a damaged rotator cuff.

Shoulder weakness is the No. 1 sign of a rotator cuff injury, says Christopher Kim, MD, an orthopaedic surgeon who specializes in sports medicine. So if you struggle to lift your arm above your head, it’s likely that there’s something wrong in this part of the shoulder.

Shoulder weakness is the common symptom across a range of rotator cuff injuries.

Like the shoulder itself, the rotator cuff is a complex set of working parts that allow you to lift and rotate your arms (hence the name). The rotator cuff is made up of four different muscles (the supraspinatus, infraspinatus, subscapularis and teres minor) and the tendons that attach them to the bone to help stabilize your shoulder joint. So you can have a problem with one or many of the muscles and suffer from the same weakness.

“People come in with similar kinds of pain and often complain of the same thing,” Dr. Kim says. “We sort out where the weakness is really coming from to figure out which part of the rotator cuff it is, and how bad it is.”

You may not easily notice the weakness yourself if, say, you can still raise up your arm. But you might feel a pain, pop or click when you move your arm a certain way or sleep on it in bed. Other times, you don’t notice it until one shoulder gives out or is noticeably weaker when you try to lift something you normally have no problems with.

Uniquely Trained to Identify Your Shoulder Issues 

Only a sports medicine physician can pinpoint your shoulder problem. Meet with Dr. Kim to improve your strength and overcome your injury. 

Make an Appointment 

Sports medicine physicians like Dr. Kim run you through a battery of tests to first identify that it’s a rotator cuff injury and not something wrong with cervical vertebra, neck, biceps or AC joint. Then they sort out the severity of the damage.

“There’s a very broad spectrum. On one end, you have impingement, bursitis and rotator cuff tendonitis. On the other end of the spectrum, there’s a full thickness rotator cuff tear. And then you have a whole bunch in between and partial tears that range from low-grade or high-grade.”

Rotator Cuff Tendonitis

The tendons of your rotator cuff can become irritated and inflamed, leading to tendonitis. It’s something that usually occurs over time, whether from sleeping on the same side of your body every night or performing repetitive motions that require you to raise your arm above your head.

“This is what some refer to as impingement or bursitis,” Dr. Kim says. “We have a bursa, which is a little fluid-filled sac around the rotator cuff that allows things to glide over each other. Inflammation can cause it to swell with more fluid, which leads to pain.”

And as you move, the space around your rotator cuff narrows. The tendons rub against other parts of the shoulder, causing more irritation and pain.

Rotator Cuff Tears

The tendons that attach the rotator cuff can also start to fray or lose their connection to the bone.

“We characterize rotator cuff tears in lots of different ways. We can define it as more the wear-and-tear, degenerative tear that happens as we get older, which is common. There are also the traumatic tears, where you have a fall or an injury. Either of these can be partial or full,” Dr. Kim says.

Partial rotator cuff tears are when there is damage, but some of the tendon is still connected. Full-thickness, or complete rotator cuff tears, are completely disconnected and look like there is a hole where the muscle should attach to the bone.

Age and repetition both wear on your rotator cuff muscles and tendons.

Traumatic tears are more common in young adults, as the result of a fall. But the majority of rotator cuff tears are of the degenerative type — the normal wear and tear your body faces over time. You’re more likely to suffer a rotator cuff tear after the age of 40. People in their 60s, 70s and 80s have a good chance of tearing a rotator cuff without even knowing it, Dr. Kim says.

With age, comes the repetition that causes these degenerative tears. By the time you’re 40, you’ve simply moved your shoulder a lot more times than through age 20. But there are other risk factors for developing a degenerative tear or even rotator cuff tendonitis.

“The non-traumatic type of tear typically happens in people who had a lot of repetitive motions with their shoulders. And that repetitive motion could be lifting heavy objects or performing manual labor where you’re constantly lifting and pulling,” Dr. Kim says. “It can actually even be repetitive desk work, like using a mouse or keyboard all day. People complain about shoulder pain with that, too.”

There are also biological, internal risk factors, he says. A history of shoulder trauma or surgery puts you at risk of a tear. So does smoking. Smokers tend to have more rotator cuff problems and more pain.

Rotator cuff pain is easy to overcome with stretches and exercises.

There’s no specific shoulder stretch, exercise or routine for you to prevent a rotator cuff injury. But that’s typically the prescription for rotator cuff problems, even up to partial tears.

“Rotator cuff treatment is so variable. Not all rotator cuff injuries are treated the same. One full-thickness tear is different from another. Partial tears are different from full tears,” Dr. Kim says. “There are a lot of factors involved, but almost always our recommendations are non-surgical. You undergo therapy with a physical therapist or do your own home exercises. And then we discuss whether a steroid injection is beneficial or not in managing your pain.”

When these more conservative treatments aren’t effective, or you suffered a complete tear, rotator cuff repair surgery is needed.

“The majority of rotator cuff surgeries are all arthroscopic. It’s a less invasive surgery but recovery from a rotator cuff repair is actually quite long. It takes much longer for soft tissue to heal back onto bone,” Dr. Kim says.

“You’re typically in a sling for about six weeks. During that time, you come out of the sling two or three times a week for physical therapy. It’s usually three months before you start any strengthening exercises — light bands and things like that. And you typically go to therapy for five to six months before continuing to improve on your own at home. It’s usually about nine to 12 months total before it’s the best you’re rotator cuff is going to get.”

Nobody wants to hear that their shoulder weakness is going to take a year of treatment and effort to heal. That’s why it’s so important to get evaluated early, Dr. Kim says.

“The longer you have symptoms, the harder it often is to treat. And the injury has progressed,” he says, “Treating a rotator cuff problem when it’s at the early stages of bursitis or tendonitis is best. People respond pretty well with non-surgical, conservative measures like injections and physical therapy.”

So as soon as you feel a twinge of shoulder pain or weakness, schedule a shoulder evaluation or visit the Bone & Joint Center to start a much shorter road to recovery.

Are You Suffering With These Symptoms of a Rotator Cuff Tear?: Dr. Matthew Pifer: Orthopedic Shoulder Surgeon

Rotator cuff tears are painful shoulder injuries that occur when there’s damage to the rotator cuff — a collection of muscles and tendons that contribute to shoulder mobility and stability. While there are numerous techniques to treat a small rotator cuff tear, a significant tear usually requires surgery for a full recovery.

Board-certified orthopedic surgeon Matthew Pifer, MD specializes in minimally invasive shoulder surgery and has extensive experience performing rotator cuff repairs. 

Most rotator cuff tears are the result of a single incident, like a sports injury. Occasionally, a bone spur in the shoulder might cause a tear. Hobbies or sports that involve repeat shoulder movements, such as baseball, tennis, and construction work, raise the risk of rotator cuff injuries.

Telltale signs of a rotator cuff tear

Shoulder pain is one of the main signs of a rotator cuff tear, but there are other signs that make it more likely. Where in the shoulder the pain occurs and how your shoulder moves provide helpful clues to the source of your shoulder issues.

In rotator cuff injuries, the pain is felt at the front of the shoulder. Because the rotator cuff enables shoulder mobility and provides stability, problems in these areas suggest a rotator cuff tear. Patients with rotator cuff tears have trouble raising their arms and reaching behind them. When you try to make these movements, your pain may worsen.

Because the shoulder is unstable, patients often notice a popping or clicking sound in the shoulder when moving the arm. This happens when the rotator cuff is unable to keep the upper arm bone in the shoulder socket. 

Some individuals report pain all the way to their elbow because nerves from the rotator cuff flow down the arm. Here are the main signs that suggest you have a rotator cuff tear. 

Movement restriction

It will be difficult to move your arm and shoulder normally if the rotator cuff is torn. Simple tasks like brushing your hair, dressing, and cooking will be excruciatingly painful. You may find it challenging to carry even small objects due to the lack of range of motion. Reaching overhead is particularly problematic when the rotator cuff is torn. 

Shoulder stiffness

If your rotator cuff is injured, your shoulder will become painful and stiff. Your arm will become much more rigid if you stop moving it. You may feel like your shoulder is frozen at times. 

Shoulder weakness

Your shoulder can’t hold as much weight as it usually can when your rotator cuff is damaged. Even something as small as a book may feel too heavy and your arm may become fatigued quickly. 

Repairing a rotator cuff

Dr. Pifer has experience repairing partial and full rotator cuff tears. The following are common approaches. 

Partial rotator cuff tear repair

When the rotator cuff tendon is ripped but hasn’t completely separated from the underlying bone, a partial repair can restore mobility and relieve pain. Surgery typically involves removing a portion of the acromion bone, which is situated on the shoulder blade. 

The ragged ends of the torn tendon are smoothed, and the inflamed bursa sac is removed. Damaged ligaments are removed in the process. 

Full rotator cuff tear repair

If the tendon has entirely torn or is completely separated from the upper arm bone, a comprehensive rotator cuff repair procedure is required. Depending on the degree of the damage, there are a few different procedures to complete a full rotator cuff repair.

Dr. Pifer specializes in minimally invasive arthroscopic shoulder surgery. With arthroscopic surgery, small incisions are created in the shoulder’s side and back, and Dr. Pifer removes any damage, such as bone spurs. He then reconnects the tendon to the humerus using suture anchors.

Only in cases of severe joint deterioration or serious injury is open surgery performed. Bone, cartilage, and tendons that have been injured are replaced using bone and tissue grafts from other parts of the body. The humerus bone’s head is then used to reconnect the tendon.

Dr. Pifer may use mini open surgery, which involves making a wider incision than is necessary for arthroscopic surgery but doesn’t involve opening the entire shoulder joint or using grafts.

Rotator cuff tears are serious business. Not only is a rotator cuff tear unlikely to get better on its own, but left untreated, it can progress into a chronic issue that causes more problems down the line.  

Trust an experienced shoulder surgeon to provide exceptional shoulder care when you need it most. Give us a call to schedule a visit with Dr. Pifer at our Santa Barbara, California office. A team member can assist you in scheduling an in-person or telemedicine appointment with Dr. Pifer.

How Sports Medicine Can Help You Prevent Injuries and Stay in the Game

Pushing your limits on the field shouldn’t mean risking your well-being. Teaming up with a sports medicine professional can be a game-changer. Uncover how this partnership helps you stay healthy and in the game.

Are You Experiencing These Telltale Signs of a Rotator Cuff Tear?

Shoulder pain can be a warning sign of a common but potentially serious injury: a rotator cuff tear. Don’t let this condition go unnoticed; learn the telltale signs and take action to protect your shoulder health.

Here’s When Arthroscopy Is the Right Course of Action

Your age and other factors play a role in whether arthroscopy is the right treatment option for your joint injury. It’s wise to meet with a specialist for a thorough evaluation and to discuss your options.

Is PRP Right for Me?

For anyone looking to speed up their recovery, platelet-rich plasma (PRP) therapy is a game-changing option. Find out how this cutting-edge treatment can help you get back to your daily activities pain-free.

How to Tell If You Have Shoulder Instability

Shoulder instability is not only painful but risky if left untreated. Having a specialist examine your shoulder is the first step to diagnosing shoulder instability. Once diagnosed, treatment eases pain and restores function.

Why You Should Consider Sports Medicine If You’re Not an Athlete

Sports medicine offers a range of benefits, and you don’t have to be an athlete to reap them. Patients with a range of issues can take advantage of sports medicine programs for preventing and treating injuries.

Arthroscopic suture of the rotator cuff in St. Petersburg

Arthroscopic suture of the rotator cuff in St. Petersburg 8 812 380 02 38 St. Petersburg

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• Arthroscopic suture rotator cuff of the 1st category of complexity (including an examination by an anesthesiologist, anesthesiological allowance, cuff fixator kit and daily postoperative monitoring)

  128 900 ₽

• Arthroscopic rotator cuff suture of the 2nd category of complexity (including examination by an anesthesiologist, anesthesiology allowance, 2 sets of cuff fixator and daily postoperative monitoring)

  171 000 ₽

• Arthroscopic suture of the rotator cuff of the 3rd category of complexity (including an examination by an anesthetist, anesthetic manual, 2 sets of cuff fixator and daily postoperative monitoring)

  193 500 ₽

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therefore, on the day of discharge, driving must be abandoned.

After arthroscopic surgery of the rotator cuff, the doctor applies a Dezo or abduction bandage. Thus, the joint must be immobilized for a period of 4-6 weeks. On the 10th day after the operation, the sutures are removed.

Sports and heavy physical activities should be avoided for 6-8 months after arthroscopy.

After the doctor removes the bandage, he refers the patient to a rehabilitation specialist (exercise doctor) to prescribe a course of rehabilitation treatment to restore the joint and muscles. As a rule, the rehabilitation course includes physiotherapy and physiotherapy exercises.

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Shoulder rotator cuff repair

Shoulder rotator cuff repair.

A ruptured rotator cuff is a serious injury with limited upper limb function. Usually complicated by subluxation of the head of the humerus.

Types of tendon rupture:
Depending on which ligaments are damaged, there are:
– Torn rotator cuff – it consists of the tendons of the subscapularis, teres minor, supraspinatus and infraspinatus muscles. All of them are interconnected and with the joint capsule, provide its mobility and integrity.
– Rupture of the tendon of the biceps muscle of the shoulder
• long head
• short head
Depending on the degree of damage, they distinguish:
– Complete rupture of the ligament – in this case, all fibers of the ligament are damaged and it is torn in two.
– Partial rupture of the ligament – not all fibers are damaged, but only part of them. This condition is called a “sprain” of the ligament.

Rotator cuff injuries can be caused by various causes:
– Acute trauma. Most often, this fall on the shoulder or elbow joint, as well as a blow to the shoulder joint area, can be accompanied by damage to the tendons.
– Chronic traumatization of connective tissue structures or muscle fibers against the background of systematic loads and performance of the same type of hand movements. This reason is most often realized in athletes who are engaged in shot put, javelin throwing, rowing, weightlifting, tennis. Also, premature cuff wear occurs in people whose professions are associated with the same type of hand movements raised up: teachers writing with chalk, painters, plasterers.
– Age-related changes. Age-related changes can lead to rupture of the rotator cuff. Over time, the tendons become weaker and more easily injured.
– Congenital or acquired change in the anatomical ratio of various structures of the shoulder joint, leading to an increase in the load on the ligamentous apparatus, capsule and muscles.
– Decrease in the strength of the ligamentous apparatus, which is of a hereditary origin, realized at the genetic level (decrease in the number of collagen fibers in the connective tissue).

The symptoms of rotator cuff injuries depend on the degree of tear (complete or partial). With a partial tear, the patient can move the shoulder through the pain and often not fully. If the tendon is completely torn, a certain movement is almost impossible, and attempts to move it are painful. For example, if the tendon of the supraspinatus muscle is damaged, the abduction of the arm to the side suffers, while the subscapularis – its introduction to the opposite scapula. The patient complains of the inability to sleep on the affected shoulder. With an acute injury, severe pain occurs in the shoulder joint.

In a chronic process, pain first occurs occasionally, associated with raising the arm up. Over time, this unpleasant symptom appears more often, intensifies at night. As a result, the pain becomes constant, and the patient cannot perform the usual hand movements: comb or take off clothes without outside help. In the absence of proper timely treatment, arthrosis of the shoulder joint is formed.

Diagnostics

A reliable determination of the localization, as well as the severity of the violation of the anatomical integrity of the muscles, ligaments and tendons of the joint, is carried out with the help of additional objective diagnostics.
An x-ray examination is mandatory, with which you can detect a sign of tendon rupture – subchondral sclerosis. It is formed due to friction of the head of the humerus against the lower part of the acromion.
If the diagnosis is in doubt and to clarify the nature and severity of the injury, ultrasound or MRI is performed, which allows examination of soft tissues, and arthroscopy can also be performed arthroscopy.

The choice of a diagnostic examination method is carried out by a doctor on the basis of a clinical examination (includes a survey, examination of the patient, performance of diagnostic tests), as well as the technical capabilities of the medical institution, providing it with the necessary equipment to perform diagnostic procedures.

Treatment:
Conservative treatment.

If the damage is not significant (partial damage), you will be offered conservative treatment.
Treatment involves ultrasound-guided injection of platelet-rich plasma into the site of injury. If necessary, radiofrequency ablation of the suprascapular and axillary nerves is performed to eliminate pain and facilitate the performance of special exercises, as well as blockades during the recovery period.

Surgical treatment.
With a complete rupture, conservative treatment is futile. Torn ligaments will not heal on their own. To repair the rotator cuff, the operation can be performed by open access or with the help of arthroscopy.

•During a surgical operation (open approach), reconstruction of the rotator cuff in our clinic is performed through a small, 5 cm long incision on the skin. Quite often, 2-3 so-called “anchor fixators” are required to fix a torn tendon. This retainer consists of an anchor and threads. The anchor is attached to the bone, and the tendon is stitched with threads. The choice of a specific type of anchor fixator is carried out by the operating orthopedic traumatologist, however, the patient is informed in detail about which fixator is planned to be used in his case. At the Anesta clinic, we use fixators from world-famous companies that have long established themselves: HEALIX ™ by DePuyMitek (a division of Johnson & Johnson) and TWINFIX ™ by Smith & Nephew.

• During arthroscopy, 4-5 micro incisions are made around the joint. Arthroscopic surgery begins with the removal of “non-viable” tissues (scar tissue) and bone growths from the area of ​​the shoulder joint.