Four years ago, I wrote a column on rotator cuff injuries. Since that time, an updated version appeared in my book, Making Sense of Medicine: Medical Matters Made Simple, and I update it again now both as a refresher, and because it is a not uncommon condition in my practice.
How Do You Know It’s Rotator Cuff?
Very simply, excruciating shoulder pain is the most common indicator that something is wrong with your shoulder, and most commonly this has to do with injury to your rotator cuff muscles.
For example, you may pull out a chair from the table, and feel debilitating pain in your shoulder. Such pain could result as well from lifting a waste basket, reaching suddenly across your body, or just reaching back to get something from the rear seat of your car. The pain from rotator cuff damage can leave you almost helpless to withstand it; it can be a constant dull ache, or pain beyond your worst imaginings.
You may also experience weakness if you lift or rotate your arm, feel a crackling sensation with certain movements, or even have pain in the affected shoulder when sleeping.
In my own experience of this, the pain was modulated using MYK treatments, and the final repair was done surgically.
What is the Rotator Cuff?
The shoulder joint is the most versatile joint in the human body. You can swing your arm high and low and back and forth, you can throw a ball or a punch in several ways, and you can grip an amazing amount of weight against your body or give somebody ‘the elbow.’
The shoulder joint consists of a small shallow socket at the end of your shoulder blade (scapula) into which fits the ball-like head of your upper arm (humerus) which is larger than the socket, like a golf ball on a tee. In fact only about ⅓ of the ball contacts the socket at any one time. The socket is made a bit wider and deeper by a flexible rim of cartilage that runs around its edge, the labrum.
To allow the variety of movements you can do, it takes the shallowness of this ball and socket partnership as well as seven muscles connecting the humerus to the scapula.
Four of those seven muscles and their tendons enable movements, but also ensure that the ball stays in the socket; together these are called the Rotator Cuff.
What are These Muscles?
A tendon is strong fibrous tissue connecting a muscle to a bone, and so each of the rotator cuff muscles has one tendon connecting it to some part of the ball. Attachment on the other end is a bit more complex, but let’s say they each have a tendon connecting to some part of the scapula. With one exception the rotator cuff muscles are named for where they attach to the scapula.
If you put your hand over your shoulder you can feel a long ridge at the top of your scapula which is called the ‘spine’ of the scapula.
The Supraspinatus connects to and runs above (supra) the spine (spinatus). It helps move your arm away from the side of your body. This is the most likely muscle to be injured.
The Infraspinatus is broad and attaches below (infra) the spine. In fact the muscle covers much of the flat part of the outside of the scapula. It helps rotate your arm away from your body, and assists in moving your arm backward. It’s the muscle next most likely to be injured.
The Subscapularis is similar to the infraspinatus except that it covers much of the underside (sub) of the scapula. Its job is to help rotate your arm toward your body.
Finally the Teres Minor is named for its shape which is long and round, the meaning of teres; it runs along the outside border of the scapula parallel to the infraspinatus. It’s the smaller (minor) of two teres muscles in that area, and its job is two-fold: assist the infraspinatus in rotating the arm away from the body, and the Subscapularis in rotating the arm toward the body.
What Happens to the Muscles?
Most likely to happen are tears in the rotator cuff muscles or their tendons. These tears can happen gradually as a result repetitive stress especially overhead movements such as pitching or forceful pulling movements, or they may happen suddenly as a result of a fall or other shoulder trauma. Tears are generally to the tendons, but the muscles themselves can be torn as well. Tears can be partial or the tendon can be completely severed from its attachment. And alas, age is a factor! Most rotator cuff tears happen to people over 40.
According to one orthopedic surgeon friend, most people over 40 have some minor rotator cuff tears, but are without symptoms. They are frequently discovered through an MRI done for some other purpose. He said he wished sometimes that the MRI had never been invented because as soon as people learn they have rotator cuff tears, however minor, they want him to do surgery that’s really unnecessary.
For these cases, self repair is possible following the old, but still valid advice for muscle problems which is RICE: Rest, Ice, Compression, Elevation. And this is the best early therapy for rotator cuff problems. Again, from personal experience of rotator cuff tearing, MYK treatments reduced my excruciating pain to a more acceptable level prior to my surgery.
In many cases the tears are bad enough that surgery is advised; you and your doctor need to negotiate this.
These days rotator cuff surgery is almost always done arthroscopically. This means that instead of large incisions, the surgeon makes four or five very small incisions through which are inserted a tiny camera (arthroscope) and the tiny tools needed to repair the tears. You will receive general anaethesia which wears off before you go home. You will also be given a nerve block which renders your entire arm mostly paralyzed, and which can take 36 hours to wear off. Nonetheless it is generally day surgery. In my case we arrived at the clinic by 7:00 am and were home by Noon.
The hardest part of surgery is after the fact because the affected shoulder needs to remain virtually motionless for a couple of weeks, and then be restored to normal function over a period of as many as six months. Unfortunately, the tears usually occur in your favored shoulder, and so if you are right handed you need to become temporarily left handed. I urge you to practice being left-handed for weeks before your surgery as your arm will be in a sling for many weeks.
Managing pain is also to be considered. You will be prescribed strong pain killers, and advised to start taking them even before the nerve block is gone. In my case, I took one pill as they suggested, but it made me feel so sick that I dreaded taking more, and did not do. Instead, I used my MYK pain relief treatments, and the recovery was virtually pain free without taking pain medications.
As with many of the conditions I discuss, prevention is by far the best therapy, and here are a few recommendations.
First and most important: keep the rotator cuff muscles strong and stretched. Most people tend to strengthen the muscles in the front of the chest, shoulder, and arm ignoring the ones in the back; it is equally important to strengthen the rotator cuff muscles. Although too long to include here, on my website, www.SeacoastMedicalMassage.com, I include a simple program to daily strengthen and stretch that might help you accomplish this goal.
In addition, avoid sudden or forceful movements such as lifting heavy objects or catching falling objects, or sports where sudden moves, forceful contact, or falls are likely. If you must do repetitive activities involving your shoulders take frequent breaks, and use ice for 20 minutes a couple of times a day.
Your shoulders will continue to serve you well over a long lifetime, but only if you have a care to keep them healthy.
Bob Keller maintains a holistic pain management practice in Newburyport. His book, “Making Sense of Medicine; Medical Matters Made Simple,” is available locally or online. Bob can be reached at 978-465-5111 or email@example.com.