How to Mend Your Rotator Cuff Injury

Supraspinatus
This muscle is the uppermost portion of the rotator cuff and permits lateral movement away from the midline of the body, allowing you to move your upper arm up the side and away from you. When your arm is raised in a forward position, this tendon and supporting bursa can be pinched which causes them to become inflamed and swollen.

Subscapularis
This muscle is the internal, medial rotator that is located at the front of your shoulder and allows you to move your upper arm inward and toward the center of your body.

Infraspinatus & Teres Major
Each muscle respectively is an external, lateral rotator that is located at the back of the shoulder. The Infraspinatus and Teres Major each maintain dynamic joint stability and allow you to move your upper arm outward and away from the center of your body.

Rotator cuff injuries may occur due to an acute trauma of some sort, or from a repetitive overhead motion (which often occurs due to sporting activities, work tasks or daily chores).

You may experience pain immediately after a shoulder injury and it is not unusual for individuals with a rotator cuff injury to have recurring inflammation and swelling. You may feel pain on top of and in front of your shoulder, which will radiate down the outside of your upper arm (the deltoid area). This pain will intensify when you do activities that require overhead or forward reaching movements. Individuals also experience more pain at night, especially while lying on the affected shoulder. Of course the amount of pain you experience will depend on the severity of your injury. Over time you will notice a loss of mobility and/or decrease in range of motion due to your rotator cuff injury. You may also experience "crepitus" - clicking, grating, crackling or popping sounds from your shoulder joint when you move your upper arm around.

There are also different symptoms that occur depending on the type of rotator cuff injury that you have:

Rotator Cuff Tendonitis or Bursitis
You will generally experience some of the aforementioned symptoms, as well as red, sore, and swollen tendons or bursa. There will be a gradual onset of pain, which will flare up when you move your shoulder in any way (especially overhead or to the side). The pain will originate from deep inside of your shoulder and you may hear a mild popping or crackling in your shoulder joint (this specifically indicates rotator cuff bursitis).

Rotator Cuff Instability
You may feel your arm slipping in and out of your shoulder socket, or you may experience a "dead arm' feeling when you raise your arm over your head or move it away from your body. If you have dislocated your shoulder, your arm bone will slip or be forced out of the socket, resulting in immediate inflammation, loss of mobility and a possible tear of your tendon(s). If this occurs, seek medical attention immediately.

Rotator Cuff Strain or Tear
Your pain may be targeted in a few specific areas, especially when you lift your arm overhead or away from your body.

Acute Rotator Cuff Tear
This occurs due to a traumatic injury and will result in a sharp and sudden pain, snapping sensation and an immediate weakness in your arm. This sharp pain will usually last for a few days, however other symptoms may last indefinitely. Your range of motion will decrease immediately as a result of muscle spasm, bleeding or pain.

Chronic Rotator Cuff Tear
This will typically occur on your dominant side and you may notice that your shoulder muscles will weaken and atrophy (decrease in muscle mass). The stiffness and pain in your shoulder will get worse over time and your range of motion will also decrease until you are unable to lift your arm out to the side or over your head.

Without a course of treatment your rotator cuff tear could lead to severe Tendonitis or Bursitis. It is important that you receive the treatment you need in order to prevent re-injury.

Cold Compression Therapy - The R.I.C.E. Method

Cold Compression Therapy is ideal for treatment within the first 48 to 72 hours after a rotator cuff injury. It is best to reduce swelling and rest your injured shoulder by administering the R.I.C.E. method.

Begin R.I.C.E. treatments by resting your injured shoulder as much as possible and restrict any movement to prevent further damage. Ice the swollen area 2 to 4 times a day for approximately 20 minutes (allow for 45 minute periods between treatments). Do not apply ice directly onto your injured shoulder as this may cause cryoburn (freezer burn to the skin) - use a piece of cloth, towel or compression wrap to protect your injury. Compress the area if possible by adding light pressure to minimize swelling. Finally, elevate your injured shoulder (try resting it on a pillow as you lie down) to relieve swelling and allow fluid to properly drain.

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Blood Flow Stimulation Therapy

If you are still experiencing some inflammation in your injured shoulder, and the area is no longer swollen you may want to explore the healing benefits of Blood Flow Stimulation Therapy (BFST). BFST decreases inflammation and increases blood circulation. Blood is the transport mechanism for oxygen, nutrients, water and antibodies, thus proper blood flow is essential when healing any type of rotator cuff injury. BFST is provided through the use of heat therapy which can be found in heating wrap products.

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Therapeutic Ultrasound

Therapeutic ultrasound is a method of stimulating tissue beneath the skin's surface using sound waves. It is like a high frequency massage that can penetrate up to 4" below the surface of the skin. The heating and massaging effects of therapeutic ultrasound have 3 primary benefits: it can speed the healing process, reduce swelling, and heal damaged tissue softening scar tissue. Essentially, the nutrient absorption rate and blood flow within the injured shoulder area will be greatly enhanced through the use of an ultrasound device. Portable ultrasound therapy is recommended and administered by many doctors and physical therapists.

When applied directly to the skin, an ultrasound head cannot effectively transfer sound waves into the body. A conductive medium (ultrasound gel) is required to facilitate therapeutic ultrasound.

Ultrasound can also be used to administer therapeutic medicines into the body which provides the added benefit of delivering soothing medicated gel to the site of the pain. This is a process known as Phonophoresis.

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A rotator cuff tear cannot heal completely without surgery; however satisfactory function can often be achieved without an operation. If you continue to experience pain, swelling or inflammation after administering the abovementioned treatments, you may require a surgery. The type of surgery that you require will depend on the size, shape and location of your injury. An orthopedic surgeon will determine which surgery is most suited for your condition.

Anthroscopic Surgery

This surgery involves inserting a small fiber optic camera into tiny incisions around your shoulder joint. The surgeon will then be able to investigate all of the soft tissues and bones inside of your joint. This will allow the surgeon to make a diagnosis and perform the repair immediately. Repairs will be made by removing dead, damaged, or infected tissue or shaving/removal of bone spurs and fragments that can catch when you rotate your arm.

Traditional Open Repair

This surgery is often preferred if you have a complex or full thickness rotator cuff tear. The surgeon will use sutures to help attach the tendon back to the tissue or bone.