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May 16, 2007

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.


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I first injuried my right shoulder with bench press. Then, I mess it up even more improvasing improper workout to push my elbow against to wall and put my body weight on it. It has been 2 years now. I've been to PT and Orthopedic so many times. But I can still feel pain and I raise my right arm forward and rotate my wrist inward with my thumb pointing to the floor. I avoid to do pushup or anything because I'll just hurt myself again. I've been diagnose with rotator cuff tendonitis, and it is the supraspinatus that's not healing. I understand there may be too much scarrd tissues, what can I do to help removing/heal those scarred tissues?
Please help!

Your symptoms are consistent with rotator cuff tendonitis. When you extend your arm out in front and point your thumb down you are basically pinching the supraspinatus tendon between the "ball" of the humerus and the coracoacromial arch.

You have spent a long time in physical therapy and seen a few doctors. What you need to do is not "get rid of scar tissue", but instead relieve pressure on the supraspinatus tendon so that the swelling and inflammation resolves.

You relieve pressure by not pinching the tendon between 2 hard objects. Lots of pinching occurs at night, just when the body should be restoring itself. There is a new brace on the market that has been very responsive to recalcitrant tendonitis. You wear it at night when sleeping for about one month. The brace has some very impressive research behind it and can be found at teterop.com

I would recommend you continue your low weight exercises as directed by physical therapy and use the brace at night. Good luck.

I have a few questions about an injury that I currently have.

On Labor Day Weekend 2007, I had a 2 day basketball tournament. The next day I was not able to fully lift my left arm (dominant) forward or to the side without a sharp pain. I don't recall any sudden impacts but I must say I do play a lot of basketball so it could just be overuse. I went to a Clinic the following week and I was told by the Dr. that it's probably the Rotator Cuff so she prescribed an anti-inflammatory drug (Naproxen) and recommended me to a Physiotherapist. Now I've been attending Physio for almost 2 weeks and have been doing a lot of strengthening exercises and deep tissue massages. I've also done a few ultra sounds in the beginning and have been getting strapped on a 4 pad machine that help circulate blood. At times it seems that the pain is going away slowly but some days it returns. I feel a sharp pain when I do pushups also. The Physiotherapist stated that she believes that I've only strained the Rotator Cuff and not a partial tear.

Would you have any idea how long Rotator Cuff strains take to heal and if my injury could actually be a small tear or something? … or any advise or tests that I could determine if it is indeed just a strain or an actual minor tear? What are the chances of me playing sports again?

Thanks in advance!


Let me give you my 2 cents. The first question is if the diagnosis is correct. About 90% of shoulder pain is caused by rotator cuff. Your symptoms are pretty much consistent with rotator cuff injury so likely your physicians are correct.

I would not get too hung up if there is a small tear versus just inflammation. Most samll tears tend to heal much like an inflammed rotator cuff.

Finally I think you have a great chance of getting back to your sports. Most people get better with physical therapy and those that don't get surgery. The surgery is effective if it comes down to it.

Finally, I will give you a few tricks that I use to help my patients. Get a lifeline usa blue jump and do about 600 jumps a day. It is the best therapy for an ailing RC. Also many people do not get their shoulder better because they are reinjuing at night when they sleep. Avoid this very common cycle by using the nighttime shoulder immobilizer a nighttime brace that unloads force fromthe RC that occurs when you sleep. You only have to wear is a few weeks.

Good luck, Dr. Mike

Hi, about a month ago I was involved in a motorcycle accident. I currently live in Mexico and the doctors here don't seem to take things very serious and don't do a complete examination as in the U.S. Somehow in the accident, whether it was me falling down on my elbow, or when the taxi that hit me when I was laying on the ground, I managed to damage my left shoulder. The joint in my left arm chipped of a piece of bone and I have two tendons damaged. They aren't sure if they are complete or just partial. The one that is damaged is the one that is right under the clavicle and the other is the one that is connected to the clavicle. Anyways, I have constant pain and swelling. The actual physical anatomy of my shoulder is distinct from my right. I can finally extended it out in front of me but my bicep hurts from doing this because my bicep is the one who is doing most of the work. Should I consider going back to the U.S. or should i just opt for a surgery???

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