Rotator Cuff Injuries in Happy Valley
What is a Rotator Cuff Injury?
Your rotator cuff is a collective of 4 different muscles that work collaboratively to provide stability and control for your shoulder. Because our shoulders have very limited passive and structural stability, the rotator cuff is paramount to healthy shoulder function.
The individual efforts of these relatively small muscles vary based on position and load. If one of the muscles is not functioning appropriately it can lead to distress throughout the system and increase risk of further injuries. Potential mechanisms of injury can include repetitious activity of small loads over long durations or a sudden large load. Examples could include: painting a room, performing overhead house or yardwork, catching a falling object of moderate weight, falling on your shoulder or outstretched hand, and car accidents.
The severity of a rotator cuff injury can be highly variable, ranging from a basic strain to a full-blown tear with the ends pulled apart like a snapped rubber band. The activity or incident pertaining to your symptom onset is a strong indicator of underlying problem but a thorough physical examination will assist in clinical judgment of damage. If deemed to be of moderate-severe intensity, an outgoing referral to see an orthopedist and/or advanced imaging, such as an MRI, will be discussed to maximize recovery potential.
With the slower onset degenerative strain or tearing, the most common underlying mechanism is related to shoulder impingement. Prolonged subtle grinding, like a mortar & pestle, leads to the progressive breakdown of the muscle tissue causing pain and damage.
Common Rotator Cuff Injury Symptoms –
- Weakness in the shoulder
- Sharp pain when lifting arm, especially to the side – away from your body
- Aching / pain in top of shoulder that may radiate up into neck and/or down the outside of your upper arm
Symptoms may impede your ability to perform many daily tasks that you would have never thought twice about. Some basic examples include: putting away dishes, vacuuming, putting on a shirt/jacket, and fastening a bra. Even if your symptoms aren’t fully preventing you from performing all of your normal tasks, it is not advisable to “push through the pain” as this can lead to further damage in these situations.
Diagnosing Rotator Cuff Injuries
Identification of rotator cuff injuries involves a comprehensive understanding of several factors. Examples of positive findings in the clinic that increase the likelihood of a rotator cuff injury include:
- Painful arc and/or quality of shoulder motion – especially overhead
- Empty can sign
- Shoulder ER lag sign
- Painful weakness with resisted shoulder ER
These test findings are interpreted by one of our Doctors during your evaluation and correlated with other personal factors such as: onset of symptoms, duration of symptoms, aggravating/relieving factors, and where you feel symptoms. In cases where a moderate to severe tear is suspected, your therapist will request you see an orthopedist for further consultation for possible surgical options if warranted. Typically, at that point an MRI is performed so the orthopedist is able to see the quality of your muscles and surrounding tissues in your shoulder.
Treatment for Chronic or Partial Rotator Cuff Tears
Often with small and sometimes medium size tears, a surgery is not recommended initially. Your orthopedist will encourage you to participate in physical therapy to identify if a full recovery is possible without the need for an invasive surgery. Older individuals, regardless of the size of the tear, are often not surgical candidates and should pursue physical therapy for rehabilitation.
In the situations when surgical repair is deemed to be the best solution, physical therapy before your surgery is often recommended. Your outcomes and prognosis after your surgery can be improved by how much strength & motion you have before your surgery.
Treatment for Post-Surgical Rotator Cuff Repairs
Initially, after your repair you should expect to be in a sling for the next 4-6 weeks while the repair is healing. Trying to engage in activities prematurely can result in a new tear or failure of the repair resulting in another surgery. It is critical to follow the advice of your surgeon to protect your surgical site.
Once cleared to begin at Ascent Physical Therapy, you will begin learning safe ways to manage symptoms, gentle restoration of range of motion, and comfortable postures/positions. Also at this point, you should expect to still be in moderate discomfort from the surgery itself and unable, or have difficulty with, performance of most of your typical activities, including sleeping. If you haven’t figured it out yet, or your surgeon didn’t mention it, sleeping is usually the most comfortable in a reclining chair following shoulder surgery.
It is important to note that experiencing shoulder discomfort after your surgery and during rehabilitation is normal. It is not our goal to cause pain however, and most activities we prescribe put you in control of the intensity. Avoiding rehabilitation activities after your shoulder because of some discomfort could lead to greatly worsened outcomes and long term problems with strength and mobility long after the pain is gone.
After cleared to begin gradual progressive strengthening, your physical therapist will teach you how to safely begin training your shoulder to restore your strength. Restoring your strength is one of the easier aspects of a rotator cuff repair. The biggest challenge for most is regaining their full range of motion. Both should be the goals though.
Treatment of Shoulder Pain from Impingement
Rotator cuff irritation can also develop from a phenomenon known as “shoulder impingement”. This typically refers to one of your rotator cuff muscles, the supraspinatus, and its positioning in a relative tunnel. When we have a muscle imbalance or poor flexibility/stiffness in the shoulder, mechanical strain can occur in the rotator cuff. The strain can be due to poor pulling angles, less than ideal length-tension relationships, and/or direct compression & friction to the muscle itself – think mortar and pestle grinding. By working with one of our top rated Physical Therapists, you will be able to correct any muscle imbalances, restore your normal shoulder mechanics, and learn prevention techniques to stop your symptoms from returning in the future.
If shoulder or rotator cuff pain has been interfering with your life, call us today to get started on a plan of care that works for you. Ascent Physical Therapy is conveniently located off Sunnyside Road in Happy Valley. We also love treating our neighboring communities of Damascus, Gresham, Clackamas, and Sandy at our top rated physical therapy clinic!