Rotator Cuff Injuries

When Injury Occurs:  RICE it!

When you experience pain in your shoulder, you may not know the reason.  In any case, the "RICE" response is the right one to follow immediately.  Here are the four recommended steps:

REST: That's right - don't push through those last few reps of an overhead lift, or complete the volleyball game.  Just stop!  You should absolutely rest the shoulder at the first twinge of pain for at least 48 hours.  If you don't, you will only increase the damage - extending the length of recovery.

ICE:  Ice pack the injured shoulder half a dozen times a day for about 20 minutes at a time.

COMPRESSION: Stabilize the shoulder with elastic bandages.  This will prevent continued injury and help reduce swelling.

ELEVATION: Keep the injured shoulder above the heart.  This means not laying completely horizontal when resting.  Prop yourself up on another pillow or two.  

If pain persists, it's time to see the doctor.

Did I Tear My Rotator Cuff?

Though certainly competing for the top spot in shoulder injuries, rotator cuff tears are not the only ones that can occur at this complicated joint.  Others maladies include:

·         Dislocation: separation of the ball of the humerus from the shoulder socket.  This can happen in any direction, but if permanent damage has occurred to the "capsule" - the tissue that stabilizes the humerus head in this joint, recurrent dislocations may occur, leading to ongoing shoulder instability.
·         Frozen Shoulder (Adhesive Capsulitis): Injuries that have led to restricted movement because "rust" sets in.  Okay - not really rust, they're call "adhesions" - bands of tissue that form on the joint surfaces that start restricting shoulder movement.
·         Bursitis: inflammation of Bursa -  that little, liquid-filled cushion between the Supraspinatus and the Acromion. It's the only thing protecting the tendon from that bony arch whenever you lift your arm up, forcing it upward as well.
·         Tendonitis: The whole area is full of tendons, so you can see that if any these become inflamed, joint pain will follow with every movement.
·         Fracture:  The top of the humerus, the ball, can fracture, but usually it's further down the neck of the humerus where this occurs.
·         Arthritis: the degeneration of the cartilage at the joints.

An x-ray, ultrasound, or MRI may be the only way to know for sure.  While is dedicated to injuries of the rotator cuff, links to experts in these other areas are referenced in the Links page.  Each of the sites listed is very good about publishing information to the public.

Do I Need an Operation?

Not necessarily.  It seems that some rotator cuff tearing is common.  Like everything else that gets used a lot, the shoulder can experience a little wear and tear.  In this case, a tear.  This is especially true of the lifting muscle known as the Supraspinatus.  One of the contributing factors to such injuries is an enlarged Acromion.  This is the bone that projects from the Scapula up and over the Supraspinatus.  Over time, calcium deposits form on its surface and cause an "impingement" each time you lift your arm.  Eventually, the Acromion's continued pressure and abrasion against the Supraspinatus will weaken it, setting it up to be easily torn by a simple bump to the shoulder.

Before recommending surgery, your doctor may have you try physical therapy to see how effective it is in restoring mobility.  However, in the case of an acute injury that leaves your arm dangling in the wind - for example, a skiing accident (see inventor's story), you will definitely need surgery to reattach things.  Whether you need surgery or not, the section on exercises will be a helpful reference on regaining use of your shoulder. 

Decision to Operate
You may have already tried, without success, to rehabilitate the shoulder via physical therapy.  Or, you know right away that the only fix is surgery.  What can you expect from both the operation and the recovery?  

The operation is typically completed through one of the following methods:
·         Arthroscopic Procedure:  pencil-size slits are opened around the surgical repair to allow instruments and a camera in to complete the repairs.  This works for smaller, less complicated repairs.
·         Mini-Open Procedure*: current techniques allow the use of a 2 to 3 inch opening to do a complete rotator cuff repair. 

While they are in there, it's highly likely that they will try to trim off some of the Acromion bone to preclude future impingement, usually providing more freedom of movement for the shoulder than was even possible before the injury occurred.

* The not-so-Mini-Open procedure is reserved for full scale tendon transfers or joint replacements.

New Friends & How to Sleep Sitting Up

The surgical anesthetic process can involve both a general anesthesia and a "block".  The general anesthesia let's you pass through the operation in a blink - pretty nice.  The block, however, leaves your arm without any feeling for the following 12 hours or so.  You may start worrying you won't get any feeling back in this cold, lifeless limb.  You will soon regret that you do.  Make sure you have strong pain medication available for when the block wears off.  If you're looking to compare stories, please check out the Inventor's Story page.

Depending on the severity of the procedure performed, you may find that sleeping horizontally - actually laying down, to be difficult.  Just in case, find the most comfortable recliner or couch in the house to be your new, temporary bed.  The trick is to be propped up so the arm doesn't start aching. 

Now you're getting ready to begin therapy, and as you start attending physical therapy sessions, you will notice that you have lots of potential new friends who are also experiencing different stages of therapy for injuries to their Rotator Cuff.  The important thing to remember here is that, as you begin stretching and strengthening your repaired shoulder, the pain does not mean that you are on the verge of re-injuring it.  Go ahead and challenge yourself to push your limits and start taking control of your own recovery through both information-gathering, and through home physical therapy sessions to regain your range of motion.  This is where the RC STRETCH device comes in, and will make possible a full, accelerated recovery.