Is Rowing Machine Bad For Rotator Cuff

 

Following a specific exercise program after trauma or surgery is a great help in returning to common daily activities. Following a well-structured muscle strengthening program also helps in returning to sports and recreational activities.

This is a generic exercise program that includes a broad range of exercises. To make sure the program is safe and effective, it should be done under the supervision of a physician, particularly if you have recently undergone surgery or have suffered a trauma. In these cases, the doctor, with the help of the physiotherapist, will guide the rehabilitation with the program that best suits the situation of the individual case.

Strengthening the muscles that support the shoulder contributes to joint stability. Keeping these muscles strong can relieve pain from some forms of joint disease or trauma and prevent further injury.

Stretching the muscles you are trying to strengthen is important for restoring normal range of motion and preventing injury. Gentle, gradual stretching after strengthening exercises can help reduce muscle soreness and maintain their length and flexibility.

Muscle groups affected by this program include:

  • Deltoid
  • Trapezium
  • Rhomboid
  • Small and Large round
  • Supraspinatus
  • Infrared
  • Subscapularis
  • Biceps
  • Triceps

This program is designed to last approximately 4-6 weeks, unless otherwise instructed by your doctor or physiotherapist. These exercises can be continued as a maintenance program even after full recovery. For them to be effective, the exercises should be performed at least 2 or 3 times a week.

 INITIAL PHASE

Before doing the exercises, it is advisable to warm up for 5-10 days with ‘low impact’ activities, such as walking or cycling.

After warming up, perform the exercises indicated in point 1 followed by the actual stretching exercises . Repeat the stretching exercises at the end of the entire program.

You shouldn’t feel pain during the exercises. In case of pain, a doctor or physiotherapist should be consulted.

If you are unsure how to perform an exercise, or how often to perform it, it is always recommended to consult your doctor or physiotherapist.

1. COMMUTER EXERCISES

Main muscles involved: deltoid, supraspinatus, infraspinatus, subscapularis.

Tools needed: none.

Reps: 2 sets of 10

Days a week: 5 or 6

Instructions:

  • Lean forward and support yourself with one hand on a shelf. Let the other arm hang freely on his side
  • Gently swing your arm back and forth. Repeat the exercise by moving the arm from side to side, repeat it again in a circular motion
  • Repeat the entire sequence with the other arm

Tips: Do not lean back with your shoulders or knees.

 

2. CROSS STRETCH

Main muscles involved: posterior deltoid (the sensation of stretching is located behind the shoulder)

Tools needed: none.

Reps: 4 on each side

Days a week: 5 or 6

Instructions:

  • Relax the shoulder and gently pull one arm to the chest as far as possible while holding it with the other hand above the elbow
  • Hold the position for 30 seconds and relax for 30 seconds
  • Repeat with the other arm

Tips: Do not pull or put pressure on the elbow.

 

3. PASSIVE INTERNAL ROTATION

Main muscles involved: subscapularis (the sensation of stretching is localized in front of the shoulder

Tools needed: a light stick (such as a broomstick).

Reps: 4 on each side

Days a week: 5 or 6

Instructions:

  • Hold the stick with two hands behind the body
  • Pull the stick horizontally as shown in the figure so that the shoulder is passively stretched (you must feel the pull without pain)
  • Hold the position for 30 seconds and relax for 30 seconds
  • Repeat for the other side

Tips: do not bend and do not turn with the body while pulling the stick.

 

4. PASSIVE EXTERNAL ROTATION

Major muscles involved: Infraspinatus, teres minor (you should feel a stretching sensation behind the shoulder)

Equipment needed: a light stick, such as a broomstick

Reps: 4 on each side

Days a week: 5 or 6

Instructions:

  • Hold the stick with two hands
  • Keep the elbow of the shoulder you are exercising close to your body and push the stick horizontally as shown in the figure until you feel it being pulled (without hurting)
  • Hold the position for 30 seconds and relax for 30 seconds
  • Repeat on the other side

Tips: keep the hips straight and parallel and do not rotate the body during the exercise

 

5. STRETCHING IN INTERNAL ROTATION (LYING DOWN)

Main muscles involved: Infraspinatus, teres minor (a sensation of stretching should be felt in the upper-external part and behind the shoulder)

Equipment needed: none

Reps: 4 repetitions, 3 times a day

Days a week: 7

Instructions:

  • Lie on one side on a flat, solid surface with the shoulder to be exercised down and the arm bent (as shown in the picture). For convenience, use a pillow to rest your head.
  • Push the arm down with the other hand as shown in the figure until you feel ‘pull’.
  • Hold the position for 30 seconds and relax for 30 seconds.

Tips: do not bend your wrist and do not put pressure on it

 

6. STANDING ROWING MACHINE

Main muscles involved: middle and lower trapezius (you should feel the exercise behind the shoulders, in the upper back)

Equipment needed: an elastic band with comfortable resistance. If you have access to a gym, you can perform the exercise with special machines. A fitness instructor can teach you how to use the machine correctly.

Reps: 3 sets of 8. As the exercise becomes easier to perform, progress from 3 sets of 12 reps.

Days a week: 3

Instructions:

  • Fold the elastic band in half and tie its ends together. The length of the folded band should be approximately 1 meter. Tie the folded band to a door handle or other fixed object
  • Hold the band with the elbow bent and close to the body.
  • Keep your arm along your body and slowly straighten your elbow
  • Slowly return to the starting position and repeat.

Tips: Try to bring your shoulder blades together while trying to straighten your elbow

 

7. EXTRA ROTATION WITH ABDUCTED ARM (90 °)

Main muscles involved: In the spine and teres minor (you should feel the exercise behind the shoulders, in the upper back)

Equipment needed: an elastic band with comfortable resistance. If you have access to a gym, you can perform the exercise with special machines. A fitness instructor can teach you how to use the machine correctly.

Reps: 3 sets of 8. As the exercise becomes easier to perform, progress from 3 sets of 12 reps.

Days a week: 3

Instructions:

  • Fold the elastic band in half and tie its ends together. The length of the folded band should be approximately 1 meter. Tie the folded band to a door handle or other fixed object
  • Hold the band with the elbow raised to shoulder height.
  • Keep the shoulder and elbow in the position obtained and stretch the elbow
  • Slowly return to the starting position and repeat.

Tips: make sure that the elbow remains at shoulder height throughout the exercise

 

8. INTERNAL ROTATION

Main muscles involved: pectoral, subscapularis (chest and shoulder exercise should be felt)

Equipment needed: an elastic band with comfortable resistance. If you have access to a gym, you can perform the exercise with special machines. A fitness instructor can teach you how to use the machine correctly.

Reps: 3 sets of 8. As the exercise becomes easier to perform, progress from 3 sets of 12 reps.

Days a week: 3

Instructions:

  • Fold the elastic band in half and tie its ends together. The length of the folded band should be approximately 1 meter. Tie the folded band to a door handle or other fixed object
  • Hold the band with the elbow bent and close to the body.
  • Keep the arm along the body and bring the arm to the body
  • Slowly return to the starting position and repeat.

Tips: keep the elbow pressed against the side

 

9. EXTERNAL ROTATION

Main muscles involved: infraspinatus, teres minor, posterior deltoid (you should feel the exercise behind the shoulders, in the upper back)

Equipment needed: an elastic band with comfortable resistance. If you have access to a gym, you can perform the exercise with special machines. A fitness instructor can teach you how to use the machine correctly.

Reps: 3 sets of 8. As the exercise becomes easier to perform, progress from 3 sets of 12 reps.

Days a week: 3

Instructions:

  • Fold the elastic band in half and tie its ends together. The length of the folded band should be approximately 1 meter. Tie the folded band to a door handle or other fixed object
  • Hold the band with the elbow bent and close to the body.
  • Keep the arm along the body and slowly rotate the arm outward
  • Slowly return to the starting position and repeat.

Tips: Try to bring the shoulder blades together while trying to pull the elbow posteriorly

 

10. ELBOW FLEXION

Main muscles involved: biceps (you should feel the exercise in front of the upper arm)

Recommended equipment: Start with a weight that allows you to perform 3 sets of 8 repetitions each and increase up to 3 sets of 12 repetitions. As the exercise gets easier add half a kilo to a maximum of 2-3 kg. Each time you increase the weight, start again with 3 sets of 8 reps.

Reps: 3 sets of 8. As the exercise becomes easier to perform, progress from 3 sets of 12 reps.

Days a week: 3

Instructions:

  • Stand with your weight well balanced on both feet
  • Keep your elbow along your body and slowly raise the weight to shoulder height
  • Hold the position for 2 seconds
  • Slowly return to the starting position

Tips: Avoid performing the exercise too fast, avoid rotating the arm during the exercise

 

11. EXTENSION OF THE ELBOW

Main muscles involved: triceps (you should feel the exercise behind the upper arm)

Recommended equipment: Start with a weight that allows you to perform 3 sets of 8 repetitions each and increase up to 3 sets of 12 repetitions. As the exercise gets easier add half a kilo to a maximum of 2-3 kg. Each time you increase the weight, start again with 3 sets of 8 reps.

Reps: 3 sets of 8. As the exercise becomes easier to perform, progress from 3 sets of 12 reps.

Days a week: 3

Instructions:

  • Stand with your weight well balanced on both feet
  • Raise your arm and bend your elbow with the weight above your head
  • Support the arm with the other hand
  • Slowly straighten the elbow and thus lift the weight
  • Hold the position for 2 seconds
  • Slowly return the weight to the starting position and repeat

Tips: Keep abdominal muscles taut and do not arch your back during exercise

 

12. REINFORCEMENT OF THE TRAPEZIUS

Main muscles involved: posterior and middle deltoid, superstem, middle trapezius (you should feel the exercise behind the shoulders, in the upper back)

Equipment Needed: Start with a light enough weight to allow for 3 or 4 sets of 20 repetitions without pain. As the exercise becomes easier to perform, add 1 or 2 kg, but do fewer repetitions. Every time you increase the weight, start with 3 sets of 15 repetitions, until you reach a maximum weight of 4 kg.

Reps: 3 sets of 20.

Days a week: 3 – 5

Instructions:

  • Place the knee on a bench or chair and lean forward so that one hand rests on the bench to balance the weight
  • Raise the arm slowly with the thumb up and stop at the same height as the shoulder, with the arm parallel to the floor
  • Slowly lower your arm to the starting position

Tips: use a weight that allows you to perform the last repetitions with some difficulty, but without pain

 

13. STABILIZATION OF THE SCAPULA

Major muscles involved: medium trapezius, tight (should be felt in the upper back and shoulder blades)

Equipment needed: none

Reps: 10

Days a week: 3

Instructions:

  • Lie on your stomach with your arms at your sides
  • Use a pillow for comfort
  • Slowly squeeze the shoulder blades towards each other and under the back as much as possible
  • Place your shoulder blades halfway from this position and hold for 10 seconds
  • Relax and repeat 10 times

Tips: do not put the neck under tension

 

14. SCAPULAR ADVANCEMENT / RETRACTION

Major muscles involved: medium and tight trapezius (should be felt in the upper back and shoulder blades)

Recommended equipment: Start with a weight that allows you to perform 2 sets of 8-10 repetitions each and increase to 3 sets of 15 repetitions. As the exercise gets easier add half a kilo to a maximum of 2-3 kg. Each time you increase the weight, start again with 2 sets of 8-10 reps.

Reps: 2 sets of 10.

Days a week: 3

Instructions:

  • Lie on your stomach with the training area dangling at the edge of the bench
  • Keep the elbow straight and lift the weight slowly trying to push the shoulder blade to the opposite side as much as possible
  • Slowly return to the starting position and repeat

Tips: do not rub the shoulder on the head

 

15. HORIZONTAL ABDUCTION

Main muscles involved: middle and lower trapezius, small round, posterior deltoid (should be felt in the upper back and shoulder blades)

Recommended equipment: Start with a weight that allows you to perform 3 sets of 8 repetitions each and increase up to 3 sets of 12 repetitions. As the exercise gets easier add half a kilo to a maximum of 2-3 kg. Each time you increase the weight, start again with 3 sets of 8 reps.

Reps: 3 sets of 8.

Days a week: 3

Instructions:

  • Lie on your stomach with the training area dangling at the edge of the bench
  • Keep your elbow straight and slowly raise the weight to head level
  • Slowly return to the starting position and repeat

Tips: Check the movement as you try to lower the weight to the starting position

 

16. INTERNAL AND EXTERNAL ROTATION

Main muscles involved: internal rotation: anterior deltoid, pectoral, subacapular, grand dorsal; external rotation: posterior deltoid, infraspinatus, teres minor. You should feel the exercise in front of and behind the shoulder, in the upper chest and back

Recommended equipment: Start with a weight that allows you to perform 3-4 sets of 20 repetitions each without pain. As the exercise gets easier, add 1 to 1.5 pounds, but do fewer repetitions. With each weight increase, increase up to 3 sets of 15 repetitions, until you reach a maximum weight of 3-4 kg.

Reps: 3-4 sets of 20.

Days a week: 3-5

Instructions:

  • Lie on your stomach on a flat surface
  • Abduct the shoulder 90 ° and bend the elbow 90 °
  • Keep the elbow bent and adherent to the support surface, slowly bring the hand while always keeping the elbow resting on the surface, thus drawing an arc with the hand.

Precautions: avoid excessive weights that cause pain while performing the exercise

 

17. EXTERNAL ROTATION

Main muscles involved: infraspinatus, teres minor, posterior deltoid. You should feel the exercise behind the shoulder and the upper back.

Equipment needed: Start with weights that allow for 2 sets of 8-10 reps (about 0.5-1 kg) and increase to 3 sets of 5 reps. As the exercise gets easier add 0.5kg up to a maximum of 2-3kg. With each weight gain, start again with 2 sets of 8-10 repetitions.

Reps: 2 sets of 10.

Days a week: 3

Instructions:

  • Lie on your side on a flat surface with the opposite arm under your head
  • Keep the arm to be trained at your side with the elbow flexed 90 °
  • Keep your elbow against your side and slowly rotate your arm while lifting the weight to a vertical position.
  • Slowly lower the weight to the starting position

Tips: do not rotate your body during exercise.

 

18. INTERNAL ROTATION

Main muscles involved: subscapularis, teres minor (you should feel the exercise in front of the shoulder)

Recommended equipment: Start with a weight that allows you to perform 2 sets of 8-10 repetitions each and increase up to 3 sets of 5 repetitions. As the exercise gets easier add half a kilo up to a maximum of 0.5 kg. Each time you increase the weight, start again with 2 sets of 8-10 reps.

Reps: 2 sets of 10.

Days a week: 3

Instructions:

  • Lie on your stomach with the part to be trained under your hip
  • Use the pillow to rest your head
  • Keep your arm under your side and your elbow flexed 90 °
  • Lift the weight to a vertical position
  • Slowly return to the starting position

Tips: do not rotate your body during exercise.

 

Rotator cuff injuries: surgical possibilities.

In the previous article we saw how rotator cuff injuries can occur and what treatments can be used.

We have seen that often, at least initially, the treatment can be non-surgical, with quite satisfactory results. However, in many cases the symptoms can persist. In these cases, and also in cases where functional demands are high, the indication for surgery becomes more stringent.

Operations for rotator cuff injuries consist in most cases in reinserting the injured tendon to the bone from which it has detached (in this case the head of the humerus). This is technically carried out thanks to metal anchors from which sutures come out. The anchor is sunk into the bone and, thanks to the sutures, it is possible to reinsert the tendon to the bone.

 

A partial injury may require similar repair or in some cases just regularization (a procedure called ‘debridement’).

A complete tear in the context of the tendon (rather than its insertion into the bone) is treated with a direct suture to join the two separate parts of the tendon.

 

 

IN WHICH CASES IS SURGICAL TREATMENT RECOMMENDED?

Surgical methods are usually recommended when symptoms (particularly pain) do not improve with non-surgical methods. Persistent pain is the main indication for surgery. Furthermore, suturing operations are recommended in the case in which the patient is very active, as in the case of sportsmen or those who work a lot with their hand above the level of the head (painters, decorators, masons, electricians, etc.).

Other factors that lead to opting for surgical treatment can be:

  • Persistent symptoms beyond 6 months
  • Width of the lesion (over 3 cm)
  • Weakness and functional limitation of the shoulder
  • Recent injury due to actual trauma

 

SURGICAL REPAIR OPTIONS

Advances in rotator cuff repair techniques have led to the development of less and less invasive procedures . Each of the methods available has advantages and disadvantages over the others, but all have the same goal: to bring the tendon to heal.

The type of repair performed depends on many factors, including the surgeon’s experience and familiarity with a particular procedure, the size of the lesion, the type of anatomy, and the quality of the tendon and bone tissue available.

In most cases, hospitalization is limited to 1 or 2 days of hospitalization.

A rotator cuff tear may be accompanied by other shoulder problems, such as osteoarthritis, bone spurs, or other soft tissue injuries. This could lead to changes in the surgical procedure chosen.

The three most commonly used techniques for rotator cuff injuries are traditional open repair, arthroscopic repair, and repair through mini-incisions (also called mini-open). The three methods have been shown to have similar long-term rates in terms of strength improvement, symptom relief, and overall patient satisfaction.

OPEN REPAIR

Although traditional open techniques are progressively becoming obsolete, a traditional incision (several centimeters long) may still be necessary today in very special cases where the lesion is large and complex. In these cases, the surgeon makes an incision on the shoulder and partially removes the deltoid muscle to have a good view and work on the injured tendon.

During an open repair, the surgeon usually removes the osteophytes under the acromion (a procedure called acromionplasty). An open repair may be a good option if the injury is large or complex and if additional reconstruction is required, such as a tendon transposition.

Open repairs were the first techniques to be performed. Over the years, technological improvements and surgical advances have progressively led to less invasive procedures.

ARTHROSCOPIC REPAIR

During an arthroscopy , the surgeon inserts a small camera, called an arthroscope, inside the shoulder. The camera transfers the images to a screen that the surgeon uses to guide miniature surgical instruments.

These procedures require very small incisions.

An arthroscopic repair, being less invasive, allows shorter hospitalization times, accelerated recovery times, less postoperative pain, less overall discomfort for the patient.

Schematic illustration of arthroscopic repair of rotator cuff injury

MINI-OPEN REPAIR

Mini-open repairs use the latest technologies and tools even though the incisions are wider than in repairs performed with fully arthroscopic techniques.

Shoulder ‘mini-open’ access

These techniques use arthroscopy to explore the joint, accurately identify and study the lesion. Some joint problems are treated arthroscopically (such as, for example, acromionplasty.

Once the arthroscopic part is completed, the surgeon repairs the tendon lesion through ‘mini-open’ incisions. During the repair the surgeon sees the lesion directly instead of through a monitor.
These techniques have historically acted as a ‘bridge’ between open and arthroscopic techniques. They are still preferred by some surgeons, particularly for some types of lesions.

 

REHABILITATION

Rehabilitation plays a vital role in restoring shoulder function. An adequate program of physical therapy allows you to strengthen the shoulder and make it regain movement.

IMMOBILIZATION

After the surgery, the treatment consists of successive stages. Initially the repair needs to be protected until the tendons have healed. The arm should be immobilized with a brace and active movements avoided for a variable period of usually 4 to 6 weeks. The period of immobilization is strictly dependent on the severity of the injury found during surgery.

 

PASSIVE EXERCISES

When deemed appropriate by the surgeon, passive shoulder exercises can be initiated with the help of a therapist. The goal is to restore the range of motion of the shoulder in the various planes of space. During the exercises the therapist supports the arm and moves the shoulder to different positions. In most cases, it starts within 4-6 weeks of surgery.

 

ACTIVE EXERCISES

After 4-6 weeks, active exercises are undertaken, even without the help of the physiotherapist. Moving muscles properly improves arm strength and control. At 8-12 weeks a real muscle strengthening program is undertaken.

It can take several months to achieve full recovery. Most patients achieve full range of motion and adequate strength between 4 and 6 months after surgery. Although it is a slow process, the commitment to rehabilitation is essential for a satisfactory result.

RESULTS

Most patients report improved shoulder function, with greater strength and less pain.

Each surgical technique (open, mini-open and arthroscopic) has similar long-term results in terms of pain relief, improvement in strength and function. The surgeon’s experience is very important in choosing the technique to achieve a satisfactory result.

Factors that can decrease the likelihood of a satisfactory result can be:

  • Poor quality of the tendon tissue to be repaired
  • Very large breaks
  • Poor patient adherence to rehabilitation and post-surgical protective measures
  • Patient age (over 65 years)
  • Smoking or using nicotine products
  • Insurance reasons

COMPLICATIONS

Fortunately, the complications of this type of surgery are limited to a small percentage of cases. In addition to general surgical risk, such as bleeding or anesthesia-related problems, complications of surgical treatment of rotator cuff tears include:

  • Nerve injuries. Although rare, injuries to the axillary nerve, the nerve that allows the deltoid muscle to contract, are theoretically possible.
  •  Antibiotics are commonly used during the procedure to reduce the risk of infections, which is always theoretically possible for any type of surgery. Additional surgical treatment and prolonged antibiotic treatment may be required if an infection develops.
  • Detachment of the deltoid.It is a possible complication for open procedures, which involve detachment of the deltoid during the surgical procedure. It is then sutured to the bone, but the repair must be well protected during subsequent rehabilitation to allow for proper healing.
  •  Early rehabilitation reduces the risk of permanent stiffness and loss of motion. In most cases, the stiffness resolves or improves with more aggressive therapy and a more intense exercise program.
  • Recurrence of the tendon injury. It is a possible complication in particular for very large lesions and in those cases in which the post-surgery indications are not strictly followed. A relapse does not necessarily mean more pain. In the event of recurrence, re-surgery may be indicated only if the pain becomes severe and there is significant loss of function.

FUTURE DEVELOPMENTS

ABSORBABLE STIRRUPS

Many orthopedic surgeons have started using absorbable stir bars. The anchors hold the sutures in place until the tendon heals. The absorbable anchors are then slowly dissolved thanks to the action of the enzymes of your body.

 

ARTHROSCOPIC TECHNIQUES

Arthroscopic techniques are subject to continuous improvement. Progress in this area allows for safer repairs and an increasing cure rate over time.

TISSUE ENGINEERING

One of the most interesting research areas is that of tissue engineering in the orthopedic field. Tissue grafts and injectable substances are continuously being developed with the aim of promoting new tissue growth and faster healing.

 

Rotator cuff injuries, a very common problem.

In a previous article on arthroscopy, I mentioned rotator cuff problems as one of the problems that can be surgically addressed with arthroscopic techniques.

In reality, the topic is much more extensive, it consists of various parts that deserve to be addressed individually. So I will devote more than one article to rotator cuff problems. It is in fact a very important issue, given the extreme frequency with which it occurs and the way it can affect everyday life.

In this article we talk about rotator cuff injuries proper.

A rotator cuff tear is a very common cause of pain and disability.Many simple activities of daily living, such as combing or dressing, can become painful or difficult to cope with.

ANATOMY

 

The shoulder is made up of 3 bones: the humerus (the arm bone), the shoulder blade and the collarbone. The shoulder can be likened to a ball joint. The convex part is represented by the upper part of the humerus (head of the humerus). This articulates with a convex surface, represented by the part of the scapula called the glenoid.

Bone Anatomy of the Shoulder

The rotator cuff physically holds these two components together. It consists of the confluence of the tendons of 4 muscles, which form a covering around the head of the humerus. The rotator cuff then attaches the humerus to the scapula and helps lift and rotate the arm.

 

The movement of the tendons is facilitated by a sliding bag that separates them from the upper shoulder bone (acormion – also a part of the shoulder blade). When the rotator cuff tendons are injured or damaged, this bursa becomes inflamed and can be painful.

 

DESCRIPTION

When one or more rotator cuff tendons are injured, the tendon no longer attaches fully to the head of the humerus. Most injuries involve the tendon of the supraspinatus muscle, but other tendons may also be involved (singly or in association with each other).

In many cases, tendon injuries begin with a weakening of the tendon, such as a string that wears progressively. As damage progresses, the tendon can completely tear. The ‘coup de grace’ can be due to seemingly ‘normal’ movements such as lifting a rather heavy object.

 

There are different types of injuries:

  • Partial injuries: These consist of damage to the tendon tissue without completely interrupting it
  • Complete or full thickness injuries: they literally divide the tendon into two parts. In many cases, injuries occur at the junction of the tendon with the head of the humerus.

CAUSES

There are two main causes: the trauma and the degenerative process.

ACUTE INJURIES

A fall on the extended arm, or lifting something very heavy with an abnormal motion, can injure the rotator cuff. This type of injury can be accompanied by other shoulder problems, such as a broken collarbone or dislocated shoulder.

DEGENERATIVE LESIONS

Most injuries are the result of progressive tendon wear that occurs slowly over time. This degeneration occurs naturally with age. Rotator cuff tears are more common in the dominant limb. If a degenerative lesion affects one shoulder, the risk of the opposite shoulder being affected is greatly increased, even if it is not painful.

Examples of rotator cuff injury

Many factors contribute to tendon wear:

  • Repetitive stress. Certain repetitive shoulder movements can overstress the rotator cuff muscles and tendons. Swimming, tennis, rowing, weight lifting are clear examples of sports that expose the rotator cuff tendons to the risk of ‘overuse’ injury. Many routine jobs and chores can be just as damaging.
  • Poor blood supply. As we age, the blood supply to the rotator cuff tends to decrease. Without adequate vascularity, the healing ability of tendon damage is impaired. This can lead to an actual tendon injury.
  • Bone spurs. As we age, bone spurs may develop under the acromion bone. In lifting the arms, they may rub with the rotator cuff tendons. This condition is called impingement and, over time, can weaken the tendon and make it easier to break even complete.

RISK FACTORS

Because most rotator cuff injuries are largely caused by normal wear and tear, people over the age of 40 are most at risk.

Repetitive activities such as lifting weights, or jobs that involve holding the hand above the head for a long time can lead to this type of injury early on. Some athletes are particularly vulnerable to overuse injuries, particularly tennis players and swimmers. Painters, carpenters, and other people who work with their hands above head level for a long time are at increased risk of developing rotator cuff injuries.

Before the age of 40, cuff injuries can be caused by the sports and work activities just mentioned, but they can also be caused by real traumatic events, such as a fall in which the shoulder joint is also indirectly involved.

SYMPTOMS

Common symptoms of rotator cuff injuries include:

  • Pain at rest and at night, particularly if you have a habit of sleeping on the diseased side
  • Pain when raising and lowering the arm or making particular movements
  • Weakness in lifting or rotating the arm
  • Sensation of crackling or roaring when moving the shoulder to certain positions

Lifting the arm can be painful if you have a rotator cuff tear

Injuries that occur suddenly, such as from a fall, usually cause intense pain. There may be a popping sensation and weakness in lifting the arm.

Injuries that develop slowly due to continued use and wear also cause pain and weakness, but symptoms have a progressive onset. It can be painful to lift your arm to your side or lower it. At first, the pain may be mild and present only when lifting the arm above the head, as if reaching for something placed high on a shelf. Common over-the-counter pain relievers at first may be enough to relieve pain.

Over time, the pain at rest may increase and stop responding to common pain relievers. The pain can also increase at night, especially if you sleep on the affected side. Shoulder pain and weakness can make even simple tasks such as combing your hair and tying clothes that close at the back, like an apron or bra, difficult.

CLINICAL EXAMINATION

After discussing the case with the patient, the doctor examines the shoulder. A specialist examination usually includes looking for any deformities or points of altered consistency of the tissues. The specialist moves the shoulder to check the range of motion in different directions and checks the strength in the various movements.

Special tests can guide the diagnosis towards the various pathologies that can affect the shoulder. Often the examination also includes the neck, as some symptoms in the shoulder or upper limb can be caused by problems with the spine.

Some particular tests are very useful in directing the diagnosis

INSTRUMENTAL EXAMS

The main tests that help the doctor make the diagnosis are:

  • Conventional radiographs. It is usually the first exam that is required. X-rays do not visualize soft tissue such as rotator cuff tendons, but they can show indirect signs and can identify bone spurs or other abnormalities in the shoulder bone conformation. Therefore radiographs remain an essential examination for the study of the shoulder.
  • Ultrasound and / or Magnetic Resonance. These studies allow for the evaluation of soft tissues, so they are ideal for studying rotator cuff tendons. These tests identify the tendon lesions, their location, the shape of the lesion and the size. An MRI can also suggest whether the injury is recent or longstanding and can show the quality of the rotator cuff muscles.

TREATMENT

If you have a rotator cuff tear and want to continue using your shoulder despite the increasing pain, the injury can worsen over time.

Persistent arm and shoulder pain are great reasons to see a doctor. Initial treatment may be to prevent symptoms from getting worse.

The goal of any treatment is to reduce pain and restore function. There are many treatment options for rotator cuff injuries, and opinions also change among various specialists. In planning a treatment plan, the specialist must take into consideration various aspects, such as the patient’s age, activity level, health status and type of injury.

There is no evidence that intervening very early gives better results than delaying surgical treatment. For these reasons, non-surgical treatment is often recommended initially.

NON-SURGICAL TREATMENT

In approximately 50% of patients, non-surgical treatment relieves pain and improves shoulder function. Shoulder strength, however, usually does not improve without surgery.

Non-surgical treatment options can include:

  •  Your doctor may suggest that you keep your shoulder at rest and limit activities where you bring your hand above the level of your head. Using a brace can help protect the shoulder and keep it still in the most appropriate position.
  • Change the type of business. Avoid those activities that cause shoulder pain and place particular strain on the rotator cuff tendons.
  • Non-steroidal anti-inflammatory drugs. Medicines such as ibuprofen and diclofenac can reduce pain and swelling.
  • Muscle strengthening exercises and physical therapy. Specific exercises improve shoulder movement and strength. A proper exercise program includes stretching to improve flexibility and range of motion, and strengthening those muscles that stabilize the shoulder and protect it from further damage.
  • Injections of cortisone drugs. An injection of local anesthetic and cortisone can be very useful, especially in those situations where there is no response to physiotherapy. Cortisone is a very effective and very safe anti-inflammatory drug when used sparingly.

Shoulder infiltration example

The main  benefit  of non-surgical treatment is to avoid the common risks of surgery:

  • Infection
  • Rigidity
  • Complications related to anesthesia
  • Long recovery times

The  disadvantages  of non-surgical treatment are:

  • No improvement in shoulder strength
  • The extent of the injury can increase over time
  • There may be a need to limit the level of activity

SURGICAL TREATMENT

Surgical treatment is recommended if the situation does not improve with non-surgical methods. Persistent pain is the main reason that leads to surgical treatment. In case the activity level is very high, such as for those workers who are used to working with the hand over their head or for certain types of sports, the specialist may recommend surgery regardless of the results of the non-surgical treatment.

Other signs pointing towards surgical treatment include:

  • Persistent symptoms for more than 6 months
  • Large lesion (over 3 cm)
  • Shoulder weakness and loss of function
  • Recent injury due to trauma

Surgery in most cases involves repairing the rotator cuff injury by reattaching the injured tendon (s) to the head of the humerus. Surgical choices may be different and should be discussed with your trusted specialist.

We enter into a fascinating topic of orthopedic surgery, about which there is still much debate on a scientific level. It deserves to be addressed separately. I will therefore devote the next article exclusively to the surgical treatment of the rotator cuff.

 

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