Shoulder Pain Talk

Rotator Cuff Injuries Aren't Only for Pitchers

Shoulder pain and rotator cuff injuries are not restricted to the professional athletes. As I have posted before, there is nothing that protects the rotator cuff and shoulder of the weekend amateur athlete from the professional pitcher - both groups of people are straining their shoulder in ways that could quickly become tears in the rotator cuff that require medical attention.

I just stumbled upon a post from the Purple Medical Blog that illustrates this same conclusion titled "Shoulder Pain: Does Your Shoulder Hurt? Maybe Its Your Rotator Cuff". As the author writes, both the amateur athlete or normal Joe share the same "repetitive stress on the shoulder" as the professional athletes who are seen hurling baseballs at 90 miles an hour through 9 innings.

What is important to realize is that your shoulder CAN be suffering from a serious condition that requires the same medical attention as the baseball pitcher, even if you aren't on the mound for the Detroit Tigers.
 

Rotator Cuff Injury Cycle

There is a frequent pattern of injury amongst those who suffer from rotator cuff inflammation. The shoulder goes through a cycle of injury followed by healing and then the patient will have a certain period of pain-free time only to re-injure it. Soon enough, the periods of pain-free times are less and the movements that cause pain are more and the threshold for re-injuring the rotator cuff lessens.

What is going on is that the rotator cuff will become injured as it is impinged under the coracoacromial arch. The rotator cuff has a very sensitive area on its superior muscle called the supraspinatus. The rotator cuff is made up of four different muscles. 90% of the injuries originate at the supraspinatus muscle. As a person goes through years of this cycling, the rotator cuff becomes scarred; becomes less flexible; it becomes more easily torn; it becomes less subtle. In affect, this rotator cuff prematurely ages and in this cycle of injury, inflammation, healing, scar tissue, the rotator cuff at some point becomes torn. The key to treatment is to break that cycle of repeated injury to allow the rotator cuff to restore some of its flexibility to reduce some of its scar tissue. Constant re-injury needs to be avoided at all cost. It delays the healing process and contributes to scare tissue and overall decreases the range of motion.

If you have a shoulder injury, it is critical to heal it quickly and completely.

Rotator Cuff and Baseball

When you hear rotator cuff injury, what comes to mind? Typically a pitcher for your local team will have been recently placed on the disabled list. Most recently Orlando Hernandez and Jaret Wright are two of the big names on their respective team’s disabled list. This is not a problem restricted to baseball players, but they are particularly susceptible to it, given the throwing motion and how that impacts the upper part of the shoulder.

Essentially, they have something called impingement syndrome and this leads to rotator cuff tendonitis. It is also called the weekend warrior syndrome. This can be exasperated by playing basketball, by serving a tennis ball, by throwing a football. It is routine to feel somewhat sore after increased activity; particularly as one ages, but if routine movements such as turning off the alarm clock or reaching on the top shelf become painful, you need attention. Most of the time rotator cuff tendonitis can be healed and managed with physical therapy and full activity can be restored.

Occasionally, steroid injections are needed and more rarely than that , surgery is recommended. The critical aspect is to treat this problem early before there is major scarring or rotator cuff tears. Keep in mind that 90% of all rotator cuff tears are the original result of chronic inflammation. It is essentially something that starts small and gets progressively more difficult. If the shoulder is hurting, medical attention should be sought more quickly rather than less.

Rotator Cuff Anatomy

The rotator cuff is comprised of four muscles and their tendons which insert at the top of the humerus or arm bone. The rotator cuff function along with the deltoid to elevate and rotate the arm. The four muscles of the rotator cuff are complex and are critical in allowing for the shoulder’s incredible range of motion; more than any other joint in the body.

The most frequently injured of the rotator cuff tendons is the supraspinatus. The supraspinatus tendon sits on the top of the shoulder and exits the supraspinatus fossa as it turns into tendon going underneath the coracoacromial arch.

This tendon is subject to significant forces of compression as the shoulder does pass under the coracoacromial ligament and that compression can lead to inflammation. Inflammation can lead to weakness, weakness can lead to rotator cuff tears, and all of these can cause significant shoulder pain.