Ask the Expert: Dr. Lawrence Gulotta, Orthopedic Surgeon, Answers Your Questions About Preventing & Treating Rotator Cuff Injuries

by Dr. Lawrence Gulotta
Dr. Lawrence Gulotta, Orthopedic Surgeon

Q1. I had treatment for a rotator cuff tear about 10 years ago. I will have to have surgery again for another tear I sustained. Can you tell me what to expect in terms of what treatment is like now (compared to 10 years ago)?

The biggest advance in the treatment of rotator cuff repairs is the use of arthroscopy. Today, a vast majority of repairs are done through small incisions in which a camera, or arthroscope, is placed. We then use specially designed instruments that allow us to repair the rotator cuff with minimal trauma to the surrounding muscles and tissues. Patients at Hospital for Special Surgery usually have this procedure done under regional anesthesia as opposed to general anesthesia. This minimizes the amount of pain and anesthesia medications that are given, thereby reducing nausea and vomiting. These improvements in minimally invasive techniques and anesthesia allow most of our patients to go home only a few hours after their procedure.

Q2. My son is a high school pitcher for his baseball team. He has been pitching for about six years now. Is there anything he can do to prevent injuries to his rotator cuff?

Here are a few tips on maintaining good shoulder health for throwing athletes:

- Limit the number of pitches thrown each game and the number of games thrown each week. For a pitcher in their freshman or sophomore year of high school, that number should be approximately 75-80 pitches per game and no more than 2 games a week. For juniors and seniors in high school, the number of pitches a game can be approximately 100, but they should still only throw 2 games a week. Make sure a coach is keeping count.

- Stretch the shoulder everyday concentrating on internal rotation. An excellent exercise to accomplish this is called the “sleeper stretch.”  To do this stretch, lie down on the side of the throwing shoulder, place the arm directly in front of the body and bend the elbow to 90 degrees. With the non-throwing hand, gently pull the palm of throwing arm down to the floor/bed such that the shoulder is internally rotated. This will help prevent tightening of the capsule in the back of the shoulder which is a very common cause of shoulder pain in throwing athletes.

- Adopt a training routine that concentrates on strengthening the legs, back and rotator cuff. Developing good core strength can help take the stress off of the shoulder and elbow without having to give up velocity (in fact, he may actually find that his velocity increases).

Q3. Recently I have been experiencing pain and stiffness around my shoulder. What are the main differences between an injury to my rotator cuff or a pinched nerve?

Differentiating between a pinched nerve in the neck and a problem with the rotator cuff can be difficult and requires an evaluation from a trained professional. In general, patients with shoulder pain from a pinched nerve have pain or stiffness in their neck as well. This pain can travel below the elbow and be associated with numbness and/or tingling. These findings are rare in patients with rotator cuff disorders. Also, patients with a pinched nerve often find that it is more comfortable to place their affected arm on the top of their head, whereas a patient with a rotator cuff issue would find this position painful.

Q4. From playing tennis for many years, I have been diagnosed with rotator cuff tendonitis. I have been following doctor’s orders with rest, medication and physical therapy but does tendonitis ever go away? Will I continue to experience flare ups?

Tendonitis of the rotator cuff is a very common cause of shoulder pain. The good news is that most patients get better with rest, anti-inflammatory medications and physical therapy. Some patients also benefit from a steroid injection into the bursa, or fluid filled sac, that surrounds the rotator cuff. This injection can reduce inflammation and make therapy more comfortable. Very few patients with tendonitis require surgery. To prevent flare ups, it is important to adopt the exercises learned in physical therapy into your fitness routine. Tennis players are overhead athletes too, so the advice for the pitcher given above regarding stretching and core strengthening also pertains to tennis players.

Q5. I think I may have damaged my rotator cuff. What is the process to diagnose a tear? What are the odds I’ll need surgery? 

The first step is to be evaluated by a physician who can perform specific physical exam tests to determine the strength of the rotator cuff. If the rotator cuff is weak on those exams, then your doctor may order an MRI to determine if a tear is indeed the cause of the weakness.  Patients with a rotator cuff tear do not always need surgery. As a general rule, younger patients who tear their rotator cuff during a specific traumatic event usually do better with surgery, whereas older patients who cannot recall when they injured their shoulder often do very well with physical therapy.

Topics: Facebook Notes, Orthopedics
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The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.

Comments

GREG KAY says:

DR GULOTTA, I RECENTLY HAD BONE MARROW STEM CELLS INJECTED IN MY LEFT ROTATORCUFF DO YOU THINK THIS WILL HELP THE QUALITY OF TISSUE IF I NEED SURGERY?IF I NEED IT YOUR STAFF WILL BE THE FIRST TO KNOW .THANKS GREGKAY

HSS on the Move says:

Hi Greg, thank you for your question. Dr. Gulotta says, “Unfortunately, there are no good clinical studies that show that injecting stem cells into the rotator cuff will improve healing. Together with Dr. Scott Rodeo, I looked at the ability of stem cells to improve rotator cuff healing in a preclinical model, and we were disappointed with the results. When we performed gene therapy on those stem cells, we started to see some modest improvements in healing. Our conclusion was that stem cells alone may not be sufficient to improve healing. Instead, the stem cells needed to be told what to do by adding genes that are specific for tendon healing. While this technology is promising, it is still far from being clinically useful. I remain optimistic though. Good luck with your shoulder.”

Alicia Solan-Teglasi says:

Dr. Gulotta, I have been advised to have surgery to repair a complete thickness tear of my left rotator cuff per an MRI ordered by my orthopedist. However, after the pain I had for a week after trying vigorous arm cardio work on the elliptical (all this occurring about 7-8 weeks ago), I now have no pain and I am able to everything I was doing before this incident. Why do I need to go through, what I am told is extremely painful surgery (I am very sensitive to pain and had a fair bit of it– due to talo- navicular coalition, difficult periods all my life, etc). Could I be treated carefully with physical therapy instead?

HSS on the Move says:

Dear Alicia — We’re glad to hear you’re feeling better. Orthopedic surgeon Dr. Lawrence Gulotta says, “What we know about rotator cuff tears is that they generally do not heal on their own. If anything, tears have a tendency to get larger with time, which makes them more difficult to fix if issues should arise in the future. That being said, some patients may function quite well even with a rotator cuff tear. The trick is to determine which patients fall into that category. The decision to fix it or not depends on several factors such as age and activity level of the patient, arm dominance, chronicity and size of the tear, integrity of the muscle attached to the torn tendon, presence of arthritis, and the degree of symptoms. My advice is to have a conversation with your surgeon about the need for repair.” Let us know if we can be of any more assistance.

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