The other day a 50 year old male patient stumbled into the office in a what appeared initially to resemble a drunken stupor of a man who just came out of a fight. His arm was dangling in this make shift “ pillowcase sling” and a ripped v neck T-Shirt. His right upper shoulder was clearly bruised like the colors of a ripe eggplant. As I got a closer look I realized he was is in serious pain by the look of the grimaces of his face with every move he made. I knew that that I had to get him in as soon as possible no matter how many others were waiting for their appointment. His eyes were blood shot and he looked like he was sedated on some really strong medication. One of the receptionists quickly filled out the insurance paperwork for him because he was unable to write with his right arm. He seemed very edgy and rightfully so. He had just come from the Orthopedist office down the street and “walked in” to get treatment.
I DON’T WANT SHOULDER SURGERY CAN YOU HELP ME?
BEFORE I even had the chance to introduce myself and listen to his complaints those were the first words out of his mouth once he entered the exam room. I briefly introduced myself and listened to his story. I knew even before he spoke that he must have fallen or pulled the muscles in his arm, BUT I continued to listen and listen. HE SAID “I OPENED A HEAVY WINDOW AND FELT A SHARP PULL IN MY UPPER SHOULDER AND AFTER THAT AND MY ARM TURNED BLACK AND PURPLE.” “I CAN’T LIFT MY ARM OVER MY HEAD WITHOUT PAIN!” He refused to sit down as he described the MECHANISM OF INJURY, and just paced the floor back and forth as he rubbed his arm to relieve his excruciating pain. As I ran to get him an Ice Pack to calm his pain he shouted out to me DOC……. “ I HEARD ROTARY CUP INJURIES CAN BE HELPED WITHOUT ANY SURGERY, IS THAT TRUE???
MY REPLY – YES, THE MAJORITY OF ROTATOR CUFF TEARS DON’T REQUIRE SURGERY!
A big sigh of relief came from him like the a pressure cooker that just unlocked the relief valve. Will I be back to “normal”? He asked with an anticipatory reply because that’s not what the Orthopedist told me!
Before I get into what happened to this 50 year old man with a HUGE FULLY RUPTURED ROTATOR CUFF INJURY ( on MRI), let me explain what I meant when I told him the MAJORITY DON’T REQUIRE SURGERY. Rotator cuff healing is a complicated topic. Why? Because the rotator cuff muscles are a group of very important muscles that really do the job of “HOLDING THINGS TOGETHER”.
MYTH- THE BONES AND LIGAMENTS HOLD THE SHOULDER IN PLACE.
The “shoulder girdle complex” includes all the bones, the upper rib cage and ligaments between joints. This shoulder architecture is really NOT supportive of the shoulder despite what most think. The shoulder is really built for more movement or mobility, than stability therefore the rotator cuff muscles are the source of “holding things together”. Over the years the muscles of the rotator cuff get all used up and the tendons get irritated inflamed and get very small tears that we can’t even sense. Over time these micro tears become larger and eventually… a FULL or PARTIAL tear of the rotator cuff can occur. HOW?
- TRAUMATIC (ROTATOR CUFF TEAR)- A blunt fall on the shoulder with or without a dislocation of the shoulders’ ball and socket component can create cause a tear specifically in the BELLY or BULK of the rotator cuff muscles.
- REPETITIVE STRAIN AND OVERUSE (ROTATOR CUFF TEAR)- : Imagine a golfer tennis player or even a baseball pitcher. With time and repeated use the Rotator Cuff can begin to frey and tear at the junction where the tendon and shoulder bone meets.
- SPONTANEOUS (ROTATOR CUFF TEAR)- – Tendons can literally “TEAR “ spontaneously with opening a “heavy or stuck window” or lifting something heavy. Tendons dry up and shrivel at the endpoint as we age. Think of tendons as rubber bands and rubber bands loose elasticity when stretched over and over. These Rotator Cuff tendons rely on lubrication from a blood supply and as we age that blood supply becomes less effcient. A spontaneous tear is usually the “straw that breaks the camel’s back” – it is the last load that the tendon can tolerate and it rips.
THE TOP THREE QUESTIONS AND ANSWERS I AM ASKED ABOUT ROTATOR CUFF TEARS
Here is some researched based medical facts you might find helpful:
- Do all rotator cuff tears require surgery? No. Physical Therapy can help 90% of people regain normal function by reducing stiffness around the injured muscles and joint and strengthening the surrounding muscle.
- Can the rotator cuff tear become larger without surgery? Yes, but SO WHAT there are plenty of other shoulder stabilizer muscles that do the work to help you lift and use your arm for normally for every day function.
- Can the rotator cuff heal without surgery?No – Its not a STAR FISH it doesn’t spontaneously grow back once its torn but YOU CAN FUNCTION NORMALLY WITH A TORN ROTATOR CUFF!
The rotator cuff of a 50 year old does not look like the rotator cuff of a 20 something.
In your lifetime expect to either develop a rotator cuff tear, or severe tendinosis ( a fraying and ripping/ wear down) of your rotator cuff muscles. HERE, I WILL GIVE YOU THE #1 SECRET TO MAKING SURE YOUR ROTATOR CUFF STAYS HEALTHY AND MAINTAINS STRENGTH AS YOU AGE! Before that I want to tell you what happened to that 50 year old with the HUGE ROTATOR CUFF TEAR!
AFTER THAT FIRST SESSION I KNEW IMMEDIATELY THAT HE WILL RECOVER AT 90% OF FULL RANGE OF MOTION AND MINIMAL PAIN! WANT TO KNOW HOW I KNEW THIS?
Here’s how …..
The DROP ARM TEST WAS NEGATIVE! AND IT WAS NOT DUE TO A FALL ( ATRAUMATIC)
When I asked him to lower his arm after I lifted it overhead for him he had full control over the arm as he lowered it. THAT’S ALL I NEEDED TO KNOW. I KNEW THAT HE WILL NOT NEED SURGERY AND PHYSICAL THERAPY WILL GET HIM BACK TO NORMAL!
The Drop Arm Test is a test that lets a Doctor or Physical Therapist know that the other muscles around the shoulder are in working order, despite the MRI showing a large tear. With this knowledge we know that the person will do well with just Physical Therapy to get back to normal everyday function.
THE SECRET TO A HEALTHY SHOULDER –
Here is the SINGLE BEST EXERCISE TO KEEP YOUR ROTATOR CUFF HEALTHY.
THE LOWER TRAP SQUEEZE. PINCH YOUR SHOULDER BLADES INTO YOUR BACK POCKET AND SLOWLY RELEASE … THIS PROTECTS THE SHOULDER AND MAKES SURE THE JOINT STAYS IN ALIGNMENT AND MINIMIZES INJURY TO THE ROTATOR CUFF.
Don’t take our word for it see what a real patient with a Rotator Cuff Tear has to say about how he recovered from his ROTATOR CUFF TEAR WITHOUT SURGERY AND HAD A GREAT PHYSICAL THERAPY EXPERIENCE AT ALLCARE PHYSICAL THERAPY OF BROOKLYN.
Get in touch if you have any questions about a rotator cuff injury info@ALLCAREpt.com and we can get you in immediately for a FREE no strings attached consultation(shoulder screening) to see if our unique approach will work for you.
Your Brooklyn Shoulder Guru 😉