if you experience pain in your shoulder when you raise your arm to reach for something overhead or prepare for a golf swing, you could have a tear in one of your rotator cuffs. A condition common among people over age 55, a rotator cuff problem can affect anyone.
The condition is degenerative, and age is a major factor. Two-thirds of the people over the age of 60 have some sort of tear in a rotator cuff. This condition also can affect a younger person, due to an accident or from repetitive overuse, such as throwing a baseball or playing the violin.
Many athletes, especially baseball pitchers, experience rotator cuff tears, says John Theodoropoulos, an orthopedic surgeon at Mount Sinai Hospital and team doctor for the Toronto Blue Jays and the Toronto Maple Leafs.
The rotator cuff is made up of four muscles that are inserted into the shoulder joint via tendons, which connect the bones of the upper arm to the shoulder blade. A tear occurs when one or more of these tendons tears off the bone — either through age-related degeneration or a trauma. Depending on the size of the tear, you could experience weakness in the arm as well as pain. Discomfort also can occur when you’re sleeping.
Pain in your shoulder can stem from other problems, says Beth Klinck, physiotherapist and clinic manager at CBI Physiotherapy in Toronto. A physiotherapist can determine if the pain is from a rotator cuff tear by moving the arm in different directions to test specific muscles. A diagnosis also can be confirmed with an ultrasound. “If we want to know the extent of the tear,” Klinck says, “then we’d do an ultrasound or [a magnetic resonance imaging scan].”
A physiotherapist may use a number of methods to treat your problem. These include exercises to improve your range of motion, ice and ibuprofen for pain, and therapeutic ultrasound or laser therapy.
Klinck focuses on strengthening the various muscles around the shoulder to compensate for the tear. “There are several muscles that take the arm in a forward, over-the-head position,” she says. “We try to develop the other muscles so that you can make that movement without irritating the already irritated muscle.”
If conventional treatment doesn’t work, you will be referred to an orthopedic surgeon, who will decide whether surgery is necessary. Surgery is performed only when all conservative treatment has failed, and if the tear is significantly affecting your quality of life.
“If people have no pain or no dysfunction,” Theodoropoulos says, “we usually tell them not to have surgery.”
Theodoropoulos treats many athletes and, when surgery is necessary, he performs arthroscopic surgery. “If you don’t cut through all the muscles to get to the rotator cuff,” he says, “you minimize the damage to other structures and the recovery is shorter and quicker.”
Although degeneration of the tendons is a major cause of rotator cuff tears, good posture can help to prolong good shoulder health. Hunching over your computer all day with your back rounded, followed by a vigorous game of basketball, Klinck says, can be hard on the rotator cuffs.
Sitting up straight with your shoulder blades down and back and your head aligned keeps your shoulders at their optimum position.
Also, be aware of repetitive “bad” patterns of movement, such as painting a ceiling. Use a stepstool to bring yourself closer to the spot you want to reach, Klinck says, and pace yourself.
While nothing can stop the degeneration, Theodoropoulos says, exercise may help to prolong the health of your shoulders. Ask a physiotherapist or trainer for guidance on exercises that will strengthen your shoulders and upper back without straining your rotator cuffs. IE