Rotator Cuff Injuries
What is the Rotator Cuff?
The shoulder is one of the most mobile joints in the body which makes it a common site of injury. The necessary stability and mobility of the shoulder are provided by the rotator cuff, a group of ligaments, tendons and muscles that surround the joint, anchor the bones in the socket and provide the ability to rotate and lift the arm.
What is a rotator cuff injury?
A rotator cuff injury is a tear in a tendon in the rotator cuff either as a result of trauma or overuse. Classic symptoms include pain, weakness, and loss of shoulder range of motion.
What causes a rotator cuff injury?
Chronic Rotator Cuff Injuries (Tendinopathy)
The highest shoulder injury rates are among overhead throwing athletes over the age of 35. The sports that require repetitive overhead throwing include baseball, and basketball and volleyball. Golf and tennis, weight lifting, and swimming all require repetitive movements of the shoulder and increase the risk of chronic cuff injuries. Senior athletes are another group at risk for chronic rotator cuff injuries due to decades of use and degeneration associated with age.
Rotator cuff tendinopathy is the most frequent diagnosis. Tendinopathy is when a tendon develops tiny tears due to overuse and degeneration from age and overuse that lead to pain at rest and at night, reduced range of motion, and stiffness or weakness in the shoulder. Tendinopathy is usually treated with nonsurgical management and physical therapy to improve strength and range of motion.
Traumatic Rotator cuff tears
Traumatic rotator cuff tears typically result from falls or collisions found in sports like football, lacrosse and hockey. Traumatic tears can also result from high energy injuries like shoulder dislocation. Symptoms include pain, an inability to elevate the arm and normal x-rays. Traumatic tears usually affect the tendon that provides the majority of shoulder stabilizing, the supraspinatus tendon. The terrible triad is a traumatic shoulder dislocation with a rotator cuff tear and damage to the nerves.
Nonoperative management with physical therapy is the cornerstone of managing a rotator cuff tear including rest, Ice, over the counter pain medication, steroid injections, and physical therapy and a rehabilitation program.
Most rotator cuff injuries are treated with nonsurgical management. Surgery is only recommended if symptoms progress, and when there are full thickness tears. However, surgery alone is inadequate to guarantee a satisfactory return of function. It must be combined with an efficient rehabilitation protocol.
The goals of rehabilitation are to improve pain and restore function. Patients can expect physical therapy to last for up to six months. The cause of a rotator cuff tear must be considered when establishing a rehabilitation program.
Rehabilitation protocols are divided into four components:
- The acute phase addresses pain, inflammation, range of motion and protection with a sling.
- The recovery phase involves muscle reeducation to correct kinetic chain abnormalities, and to improve flexibility, and strength. A kinetic chain is a sequence of muscle activations that result in an integrated biomechanical task. Impairment of the chain can create dysfunction leading to pain and injury.
- The functional phase involves exercises directed to specific sports activities, and
- The Return to Sports phase is based on clinical recovery, kinetic chain principle, and appropriate sport techniques.
Return to play
Most athletes (70.2%) were able to return to preinjury levels after arthroscopic surgical repair. Recreational sport participation (73.3%) was associated with higher rate of return, competitive sports (61.5%) and overhead sports (38%) were associated with lower rates of return.
Studies report that athletes aged 30 and younger show excellent functional outcomes after arthroscopic rotator cuff repair. Many active patients aged 70 and older desire joint preserving arthroscopic surgical repair. Studies report high success rates with good outcomes and pain relief.
Center’s for Advanced Orthopaedics team of sports, rehabilitation and surgical professionals offer next level training, surgical expertise, and rehabilitative care as part of a holistic care program to get you back to the sports you love better than ever.