Rotator Cuff Injury Treatment

Brad Muse  0:05 

In this video, we’re going to talk about the dreaded rotator cuff injury. Something that we hear a lot about. It’s walking in the door every single day. People are living their lives with this kind of thing. So, in order for us to really dive into rotator cuff injuries and how we treat them here at CCRC, first, we need to talk a little bit about the anatomy. So, what is the rotator cuff?


Richard Ulm  0:25 

Yeah. The rotator cuff is a very, very common injury that you’ll see. And the rotator cuff is actually a collection of four muscles that sits around the shoulder, and it’s actually underneath your deltoid. So, this big muscle that you have right here, underneath that are these very, very thin, but incredibly critical muscles that sort of control the shoulder. So, they wrap around the arm bone, the humerus, and they actually manage controlling the positioning of the arm bone inside the shoulder socket as you bring your arm through wide varieties of movements. Now, they’re not very good at producing a lot of force. So, if you’re doing a bench press, or you’re doing a pull-up or something, they’re not creating the movement so much as they’re making the micro-adjustments to the joint to keep everything in a very, very safe and protected way. If they get damaged, which often happens, then your body’s ability to keep your shoulder in a good position may be compromised. Now, that doesn’t mean that you’re necessarily going to have some pain. But when you have a rotator cuff tear, that would be a tear of the muscle or the tendon, one of those four. Then, that oftentimes is going to give you symptoms, like it’s very common to get symptoms down here, or even into the shoulder itself. Sometimes, you’ll get pinching when you raise your arm up, that’d be just shoulder impingement. Or there’s a painful arc where you get here, and it kind of hurts a little bit, and then it goes away, and then it comes back at the top sometimes. It just depends on which of the four muscles were actually damaged.


Brad Muse  1:57 

Yeah. So, a little bit of good news; bad news. The bad news is many people are walking around with some kind of rotator cuff strain, tear, or dysfunction in that area. The good news is, for many, this is completely normal. So, especially as we age, we may begin to see fraying or tearing in the rotator cuff. And just because we have that does not mean we have to have pain. And, in reality, we see a lot of very high-performing individuals like those in the Major League performing, throwing with these issues, but it causes no symptoms. So, very often, we may see something like that on an MRI, but the individual may not actually have any sort of pain associated with it. So, it’s very similar to something like arthritis. We all have it, it’s kind of normal aging. And just because you see that on some kind of imaging does not necessarily mean it’s a surgical case.


Richard Ulm  2:46 

Yeah. That’s kind of understanding, sort of getting to the nitty, gritty detail a little bit. But that you have sort of structural paradigms in the medical field and functional paradigms. A structural paradigm, or a structural diagnosis would say, “We’re just going to look around and take pictures and figure out which is the most abnormal anatomy.” Where’s the structural damage? In this case, it would be a tear in one of the muscles of the rotator cuff. And then, they assume that, well, that tear has to get fixed if you’re going to get rid of the symptoms, which is not true. The way that we sort of look at it more is we’re, of course, accounting for structural changes, structural damage, but we’re going to emphasize the function. And, as Dr. Muse has mentioned, there are many, many, many. The majority of Major League Baseball players have torn rotator cuffs. The majority of professional tennis players have torn rotator cuffs. And yet, they have incredibly high-functioning shoulders. So here, we’re actually going to emphasize more the functional piece of it than the structural. It’s not like that we ignore the structural one, but we just know, there’s lots of research to back this up, that you can improve someone’s function in the shoulder, the low back, the hip, whatever. And despite having structural changes in that area, you can get them completely pain-free. I myself have a torn labrum on my right shoulder, and it functions perfectly well because I’ve rehabbed it. So, the prognosis can actually be really, really good despite the fact that it’s incredibly limiting reaching across to grab your seat belt, or if you got to reach in the backseat of a car, or you’re reaching up to a high spot, you might get some of that pinching there. But it’s very, very fixable with rehab. So, what would we do?


Brad Muse  4:25 

Well, like Dr. Ulm just mentioned, we have the structural and functional paradigm of where on the spectrum do people fall. And we’re not going to sit here and say if there is a full-thickness tear involving numerous tendons and the person can’t even lift their arm above, well then maybe that is more of a structural issue that we have to address. But that’s something we’re going to figure out through the exam and the treatment. So, in this case, especially if we have some kind of structural deformation of that tissue, maybe there is some fraying, partial thickness tear, this is a case where we do need to be a little bit more on the isolational side. And what I mean by that is very specific exercises that are going to target that muscle specifically to basically build strength and kind of force collagen lay down or like the…


Richard Ulm  5:14 

Strengthening of the tissue.


Brad Muse  5:15 

Yes. Strengthening of the tissue. But then, something that we also always talk about is integration. It’s how then do we take this shoulder, that this is the injured shoulder, maybe there’s some fraying of that tendon, and how do we integrate that into the overall function of the shoulder? So, that’s where we come in more with things like dynamic neuromuscular stabilization, but then pairing that with some really good specific exercise to target these tendons specifically.


Richard Ulm  5:41 

Yeah. We have videos on dynamic neuromuscular stabilization, so faux pas for him to just drop it and not explain it.


Brad Muse  5:46

Watch that video.


Richard Ulm  5:48

(Laughs) What he means by that is we’re going to have cases where we want to strengthen the tissue itself. We want to make the muscle thicker, want to make the tendons stronger so they can do the thing they need to do. But the other piece of it, that functional integration piece where we would use DNS, think of that as going to be more bigger movements. More, quote-unquote, ‘functional’ movements, meaning they’re very similar to what you might be doing in your everyday life. So, we might have to teach someone how to sort of control their shoulders as they reach across their body. We might use a push-up motion, or laying on their side, or getting in on their hands and knees. These are bigger movements where we take the now newly strengthened muscle that we did with the isolation exercises, but now we’re integrating it so that it actually does its job in your everyday life. So, I guess the bad news is you might have shoulder pain if you clicked on this video, that shoulder pain might be coming from a torn rotator cuff. The good news is the vast majority of shoulder rotator cuff injuries, even if it is diagnosed on an MRI, or if you’ve gone to your medical doctor and they said, “Oh yeah, you tore your rotator cuff,” there is a huge percentage of the time that these are fixable things with these isolation exercises, and then also some of the integration exercises. So, if you want more information on our functional approach, please click on one of the videos on dynamic neuromuscular stabilization. But hopefully, you found this video useful. And hopefully, we’ll be able to get rid of your shoulder pain. Thanks.

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