Rotator Cuff Tear
There are four muscles that comprise the rotator cuff: Supraspinatus, Infraspinatus, Teres Minor and Subscapularis. A rotator cuff tear is when one of those muscles or the tendon from the muscle is either partially or completely torn. The supraspinatus is the most commonly torn muscle due to its compromised position under the acromonion, or point of the shoulder. While some tears require surgical intervention, the presence of a tear on an MRI or MR Arthrogram does not necessarily mean that surgery is needed, especially in someone over 50 years of age. Some of the most prominent orthopaedic surgeons in the country agree that the symptoms are key in determining the need for surgery. This is where Sport and Spine Rehab is key. We are able to do a full, comprehensive examination of the shoulder complex to determine the appropriate course of treatment for you. If it is determined by your health care team that surgery is not indicated, then the treatment normally involves functional rehabilitation using Funhab(TM) principles. Kinesio® Taping Method and Graston Technqiue® can also be very effective at treating this condition.
Rotator Cuff Tendinitis/Tendonosis
The rotator cuff is a set of four muscles (Supraspinatus, Infraspinatus, Subscapularis, and Teres Minor) that lie over the humeral head in the shoulder that help provide shoulder stability. These muscles can become inflamed and produce shoulder pain. The pain tends to be:
- Generally worse at night or after activity
- Shoulder motion causes pain and is limited
- More common in athletes who do a lot of throwing
- More common in older individuals (over 50)
If the pain is severe, it can be difficult to distinguish between rotator cuff tendinitis and a cervical radiculopathy. Tendinitis may be associated with a rotator cuff tear, which can be diagnosed with an MRI scan.
Treatment includes conservative treatment to decrease pain and inflammation, improve muscular coordination, identify and correct underlying causes and finally to strengthen the rotator cuff.
If a tear is present, surgery may be necessary to repair the torn muscle/tendon. In many cases, there may be bursa involvement (subacromial bursa), which can cause bursitis. There also may be underlying issues in the cervical and thoracic spine (neck and upper back), which need to be identified and corrected.
Shoulder Labral Tears
The labrum is a cartilage cuff in the shoulder joint. Depending on where the tear occurs, the pain will present differently. Most commonly, symptoms include an aching in the shoulder joint, clicking or catching of the shoulder with movement, and pain with specific activities. Labral tears are commonly seen in patients who have dislocated their shoulder as well as baseball, volleyball, and tennis players (due to overhead activity). Occasionally, surgery is required to repair the tears, however, ice, stretching, and strengthening exercises can be effective in resolving the problem.
Adhesive Capsulitis/Capsulosis Frozen Shoulder
A frozen shoulder is a shoulder joint with significant loss of its range of motion in all directions. Long-term immobility of the shoulder joint can put people at risk to develop a frozen shoulder. Frozen shoulder is the result of inflammation, scarring, thickening, and shrinkage of the capsule that surrounds the normal shoulder joint.
Shoulder AC Joint Separation
A shoulder separation is an injury to the acromioclavicular joint on the top of the shoulder. A shoulder separation occurs where the clavicle and the scapula come together. The two most common descriptions of a shoulder separation are either a direct blow to the shoulder (often seen in football, rugby, or hockey), or a fall on to an outstretched hand (commonly seen after falling off a bicycle or horse).
Shoulder dislocations are when the “ball” of the “ball and socket joint” gets forcefully moved out of the “socket” normally through trauma (in sports, a fall, a car accident, etc.). These can occur in any direction (front, back, or down), but the most common is the anterior (front) dislocation. A shoulder dislocation can be a very serious injury, especially if it is not able to relocate itself on its own (called spontaneous relocation). In those cases, the patient should go to the nearest emergency room to have the shoulder joint put “back into place.” In other cases, the shoulder muscles need to be specifically strengthened so that they can help to prevent another dislocation. This is best accomplished using Kinesio® Taping Method and Funhab(TM) which strengthen the muscles that are weak and loosen the ones that are too tight. It is also vital that the shoulder blade muscles, called the scapular stabilizers are in the proper balance in order to help position the shoulder in a way that minimizes the risk for injury.
Thoracic Outlet Syndrome
TOS occurs when the nerves and vascular structures from the neck get compressed as they run through the shoulder into the upper extremity. Tests upon physical exam can usually identify the location of the compression. Many times, there may also be compression in the spine or further down the shoulder, elbow, arm or hand. Symptoms may included numbness, tingling, weakness, pain or blanching of any of the fingers. Conservative management can be very effective in treating TOS without drugs or surgery.