What is the Big Deal with the Rotator Cuff?

The rotator cuff is made up of a set of four relatively small tendons in the shoulder called the supraspinatus, infraspinatus, subscapularis, and teres minor. Their job is to keep the ball of the shoulder joint in place. This task may sound relatively simple, but consider the enormous forces that sometimes pass through the shoulder, causing serious strain on these small muscles. If they fail, a combination of pain, weakness, and inefficient mechanics may prevent you from performing certain activities such as sports or your job.

The good news is that rotator cuff injuries can be prevented, and if caught earlyenough, can often be treated with physical therapy, medications, and injections. However, more serious rotator cuff injuries may require surgery. The providers at Elite Sports Medicine and Orthopaedic Center are experts at diagnosing and treating rotator cuff injuries and getting you back to normal activities as quickly as possible.

When the Rotator Cuff Fails

There are three stages of rotator cuff injury. The first stage is tendinitis, a simple inflammation of the rotator cuff, which can be painful but is relatively simple to treat. The second stage is tendinosis, in which the tendons of the rotator cuff start to degenerate. The third stage is a tear of the rotator cuff.

Tendinitis and tendinosis can usually be treated with physical therapy, medications, and injections, with a high success rate. Very small tears, or partial tears, may also be treated conservatively, but generally larger tears, or complete tears, will require surgery. Surgery is followed by intensive physical therapy to regain shoulder motion, rebuild the rotator cuff strength, and help prevent a future injury.

Signs of a Rotator Cuff Injury

The best way to successfully treat a rotator cuff injury is early recognition. This can mean the difference between conservative treatment and surgery, and the difference between returning soon to the game or job and an extended absence while recovering.

Early warning signs of a rotator cuff injury include:

– Pain in the shoulder when getting dressed, particularly when you are putting on or taking off a shirt.
– Pain in the shoulder when reaching behind the body, such as reaching into the back seat of a car.
– Pain in the shoulder when attempting overhead activities.
If any of these signs persist for more than a couple of weeks, you should get your shoulder evaluated promptly.
Signs of a more advanced rotator cuff injury include:
– Weakness or a sense of instability in the shoulder.
-“Night pain” in the shoulder: Pain experienced when you are lying on your back and resting, or pain that continues through the night.
– Constant, intractable pain in the shoulder.

If you have any of these symptoms, you should get your shoulder examined immediately. People over 50 years of age who experience any of these symptoms are considered high risk for rotator cuff tear.

Rotator Cuff Treatment

Every rotator cuff injury has its own unique cause, particular damage, and best path to recovery. After examination in the clinic, the majority of people will require an MRI to confirm a diagnosis. Once the diagnosis has been made, we can create a personalized treatment program that may include physical therapy, injections, medications, or surgery. The in-house physical therapists at Elite are in tune with rotator cuff injuries and post op care, and work closely with the providers to develop a personalized treatment plan.

Sometimes, conservative treatment fails to improve your pain and the only option is surgery. The surgeons at Elite Sports Medicine use the most advanced surgical options available today. Most of the time, a rotator cuff tear can be treated arthroscopically, which means that the surgery is minimally invasive. The surgeon uses a small camera and small instruments to surgically repair the rotator cuff without the need for a large incision or overnight stay in the hospital.

Occasionally, rotator cuff tears are so large or have persisted for such a long period of time that they are no longer repairable arthroscopically. When this is the case, more invasive surgery may be needed to remedy the pain. This surgery may include replacing the shoulder joint.

Rotator Cuff Injury Prevention

Keeping the rotator cuff muscles strong and flexible is the best way to prevent a rotator cuff injury. Major League baseball pitchers make rotator cuff training one of their top priorities in the off season because they know they will have longer, more successful careers if they do. Any qualified coach, athletic trainer, or physical therapist, should be able to guide you in developing a rotator cuff training program. Anyone at risk for rotator cuff injury should strongly consider starting and sticking to such training. The trainers and therapists at MPower Fitness are available and willing to help set you up with such a program.

In conclusion, the rotator cuff, although small, plays a large part in the function of your shoulder. If an injury is ignored, it can lead to the need for extensive surgery and can potentially cause a lifetime of pain. Do not ignore your shoulder pain. Give Elite Sports Medicine and Orthopaedic Center a call today at 615-324-1600 and get your shoulder checked out by one of our excellent providers because, your rotator cuff matters more than you think!

Will Gailbreath, ACNP-BC

Vitamin D, Bone Health, and Ideas for Supplementation

The role of Vitamin D supplementation in osteoporotic and osteopenic patients has been well known for quite some time.  In fact, Vitamin D supplementation along calcium supplementation and weight bearing exercises are regarded as first line treatment in osteopenia and mild cases of osteoporosis.  In recent years, studies have shown the benefit of Vitamin D supplementation in other bone diseases (particularly when a deficiency is present) including healing of stress fractures and spinal fusions.

So how do we get Vitamin D?
One option is through diet.  Oftentimes milk is fortified with Vitamin D, which is convenient given thefact that Vitamin D helps our bodies absorb calcium.  Many types of fish, including salmon and swordfish, also provide Vitamin D.  One of the highest dietary sources of vitamin D is cod liver oil.  However, if you are like me, that does sound very appetizing.

We can also obtain Vitamin D through dietary supplements that are available at local pharmacies and health food stores.  Recommendations for dosing depend on nutritional status and comorbid medical conditions (i.e. underlying endocrine abnormalities).

My personal favorite way is to obtain Vitamin D via sun exposure (of course keeping in mind the importance of also protecting skin from sun damage).  While options to enjoy the great outdoors are more limited in Middle Tennessee in the colder months of the year, there are still plentiful options in town and within short driving distances.   Fall in particular can be a great time to enjoy the beautiful colors and it seems like this year has been particularly spectacular. 

1.    Local hikes – Percy Warner Park and Radnor Lake both offer great trails for hiking.   Both have trails of varying distances and difficulties.  Percy Warner allows running and dogs on all trails.  Radnor only allows dogs and running on Otter Creek Road.
2.    Waterfalls – There are MANY waterfalls within just a few hours drive of Nashville.  As a girl who grew up in Kansas, I did not have many opportunities to see these wonders of nature growing up, so I’m always thrilled for the chance to discover a new one.  Cummins Falls and Burgess Falls are located a short distance from Cookeville and can easily be seen in one outing.  Fall Creek Falls, which is a little further away, also offers great options for camping and hiking.
3.    Mammouth Cave – While the touring the cave itself obviously does not offer any source of Vitamin D, there are hiking trails around the entrance of the cave that are worth hiking and biking.  And for the record, the caves are worth touring too.
4.    Biking – Nashville has done a great job of providing greenways as an option for shared use off street trails.  The Natchez Trace is another great option for those looking for a scene paved/road option.   The recent installation of Nashville B-cycles is a fun way to get around town for those without a bike or looking for a less strenuous option

The above are just a few of the MANY ways to enjoy being outside.  I have found the smartphone app NashVitality to offer some great ideas as well.  Cumberland Transit, a local outdoor adventure store, often has events to promote various outdoors activities as well.

Sunyecz, John C, (Aug 2008). The use of calcium and vitamin D in the management of osteoporosis. Ther Clin Risk Manag. 4(4).
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2621390/

McCabe, MP, Smyth, MP, & Richardson, DR, (Jun 2012). Current concept review: vitamin D and stress fractures. Foot and Ankle Int. 33(6). http://www.ncbi.nlm.nih.gov/pubmed/22735329

Stocker, G, Buckoski, J, Bridwell, K, Lenke, L, Riew, K.D, & Zebala, L, Preoperative Vitamin D Status of Adults Undergoing Spinal Fusion. Presentation notes available online at: http://www.abstractsonline.com/Plan/ViewAbstract.aspx?sKey=b9eb264c-a11b-4673-8233-5d6de5b4d4ef&cKey=100f99b4-71c1-4e72-b0de-22891e972bd7&mKey=%7bBA8AA154-A9B9-41F9-91A7-F4A4CB050945%7d

(Jun 2011). Vitamin D Fact Sheet for Health Professionals. http://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/#h3