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Ask Dr. Rick – May 2010

May 10, 2010

Rotator Cuff Injuries

One of the most common injuries we see in a Sports Medicine practice includes injuries to the shoulder. Injuries to the shoulder can occur in throwing athletes, in swimmers or in any overhead activity type of sports as well as in the common population. One of the most common injuries seen in the shoulder is a tear of the rotator cuff. Rotator cuff tears can be separated by partial tears and complete tears. Today, we will discuss complete tears of the rotator cuff.

The rotator cuff is comprised of four tendons. Those tendons are the structure that creates the rotator cuff. The most commonly injured tendon in the rotator cuff is called a supraspinatus. That is the tendon that is injured with repetitive throwing and excessive trauma to the shoulder. The function of the rotator cuff is to provide compression and hold the shoulder in the joint, as well as to provide rotation and allow the shoulder to move. One of the most common findings in an overhand thrower, such as a baseball pitcher, is a decrease in velocity as well as pain. In an athletic population, rotator cuff tears should be treated surgically with arthroscopic techniques to repair the rotator cuff. After a rotator cuff repair, the shoulder should be immobilized for a period of time ranging from 4-6 weeks and should then be rehabilitated with a standard rotator cuff program that transitions into an interval throwing program.

Early in the disease process, many physicians felt that early motion of the shoulder after a rotator cuff repair would enhance healing. This has been found to be untrue. Immobilization for longer periods of time has shown to result in a better rotator cuff repair outcome.

Rehabilitation is a hallmark of return to throwing sports. This is inclusive of rehabilitating the rotator cuff, the posterior shoulder muscles, the anterior shoulder muscles and the athlete’s central core, as well as the leg and the hip. A recent addition to our surgical regimen is placing PRP (Platelet Rich Plasma) at the site of the repair to enhance healing. Depending on the size of the rotator cuff tear, rehabilitation can take between 6-9 months to return to full unrestricted activity.

Dr. Rick, I really enjoy your column and it has taught me a great deal. I am an avid cyclist and have been having pain on the outside part of my leg just above my knee. It burns when I ride and when I walk upstairs, it is painful. When I sit for a period of time and get up, it is very painful. I have taken some over-the-counter anti-inflammatories and this has not seemed to help. Can you please help me?
– Steven K., Wildwood, MO

Steven, thank you very much for your question. I am glad that you enjoy our column. You have lateral iliotibial band tendinitis, which occurs as your iliotibial band rubs on the large prominence of your lateral femur. Your femur is your thigh bone. This occurs with repetition and can quite frequently be seen in runners and cyclists. Treatment for this includes rest, physical therapy to stretch the iliotibial band, modalities such as ultrasound, heat and occasionally phonophoresis, which is a technique during which a physical therapist can penetrate hydrocortisone into the soft tissues. You need to visit your physician and get started on a very focused treatment for your iliotibial band, as well as a prophylactic program so you can continue to ride.

Dr. Rick, Thank you very much for taking my question. I have had low back pain ever since starting a weight training program and this has gotten worse over the last several months. The pain stays in my back and makes my back very stiff. Do you have any thoughts?
– Mark W., Belleville, IL

Mark, your back pain is most likely coming from the soft tissue in your back or your sacroiliac joint as opposed to a pinched nerve or herniated disc. The fact that the pain does not go down your leg and you have no neurologic symptoms, meaning it is staying in your back, is very helpful. To try to address this pain initially, I would change your exercise regimen to a low-weight, high-repetition exercise program. Any extension or bending backwards of your back needs to be eliminated and if you are doing any type of bench press or military press activities, your back needs to be straight during the activities. You should not be arching your back and again, this should be a low-weight, high-repetition program.

Added to a decrease in the stress to your back with your activities needs to be a stretching program and a knee to chest program, which are readily available on the internet or please contact our office and we would be happy to mail you a copy of our low back exercises. If this pain does not resolve in the next four weeks, you need to call your physician and allow him to evaluate your low back with an x-ray and possible MRI of your back. Thank you very much for your question and good luck.

Dr. Rick’s medical tip for the month of May: Decrease your intake of refined sugars. No candy. No sweets unless they are fruit and increase your intake of leafy green vegetables.

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