Ask the Expert: Dr. Lawrence Gulotta, Orthopedic Surgeon, Answers Your Questions About Preventing & Treating Rotator Cuff Injuries
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.
Dr. Lawrence Gulotta is an Orthopedic Surgeon at Hospital for Special Surgery, specializing in shoulder surgery and sports medicine. Dr. Gulotta’s interests include arthroscopic and open surgery, as well as non-operative management of shoulder problems. He currently serves as a reviewer for the Journal of Bone and Joint Surgery, the Journal of Shoulder and Elbow Surgery, Clinical Orthopaedics and Related Research, and the Journal of Orthopaedic Research. He is also on the Editorial Board of the HSS Journal.