Are you experiencing pain in the shoulder that makes you cringe whenever you move it? The pain is impacting everything you do, making both work and play almost impossible. You may have even been diagnosed with a problem of the Rotator Cuff, or some type of tendinopathy, which may include tendons that are worn, injured, stretched, or even torn.
Four muscles inside of the shoulder allow us to rotate our arm. These four muscles form a cuff of tendons around the top of the arm or the humeral head. If the rotator cuff is torn, it means there is a tear of one or more of the tendons of those four rotator cuff muscles of the shoulder. A rotator cuff “injury” might include any type of irritation or overuse of either the tendons or the muscles.
The shoulder is made up of two joints, the glenohumeral joint and the acromioclavicular joint. The glenohumeral joint is a ball and socket joint formed by the top of the humerus and the socket of the scapula. The four muscles and tendons of the rotator cuff surround the glenohumeral joint and hold the head of the humerus into the scapula. The rotator cuff functions to stabilize the shoulder and allow the arms to move through a full range of motion. The rotator cuff works together with the deltoid muscle to provide motion and strength to the shoulder for activities that require motion above the waist and shoulders.
Tendinopathy, Tendonitis, and Tendinosis
Yes, these words look pretty similar, but they mean different things. Tendinopathy is a problem of the tendon that results in pain, swelling, and impaired function. Both tendonitis and tendinosis are a type of tendinopathy. Tendonitis is an inflammation or irritation of a tendon. If left untreated, tendonitis can become tendinosis, which is a degeneration of the tendon.
In the rest of this article, we will concentrate on rotator cuff tendonitis. Tendonitis is more common in adults over 40 years of age, as the tendons become less elastic, tolerate less stress, and are more susceptible to injury.
Rotator cuff tendonitis occurs when the small muscles of the rotator cuff, the supraspinatus, infraspinatus, teres minor, and subscapularis, become strained causing weakness of these structures and subsequent tendonitis. While the deltoid muscle is the big and strong muscle of the shoulder, as seen on many well-built athletes, the small and relatively weak rotator cuff muscles perform key functions. The supraspinatus helps seat the humeral head (ball) into the glenoid cavity (socket) when the arm is raised from the side (abducted). The infraspinatus and teres minor rotate the forearm away from the body or in the hand-waving position (external rotation), and the subscapularis rotates the forearm towards the body (internal rotation). Once the balance between motion and joint stability is altered through weakness in structures like the ligaments, tendons, and muscles of the rotator cuff, pain and impaired function will invariably be the result. This condition is often caused by or associated with repetitive overhead activities, as the rotator cuff is most vulnerable in this position.
The tendons of the rotator cuff pass underneath a bony area on their way to attaching to the top part of the arm bone. Rotator cuff tendonitis arises when inflammation or bony spurs narrow the space available for the rotator cuff tendons. Sandwiched between the two bones, wear and tear of the rotator cuff takes place, exacerbating this inflammation and pain.
Rotator cuff tendonitis refers to irritation of these tendons and inflammation of the lining of these tendons. Rotator cuff tendonitis most often occurs as a result of activities in which the arm is moved over the head repeatedly, such as tennis, pitching, swimming or lifting weights over the head. Other causes of rotator cuff tendonitis include occupational overuse, such as working with the arm overhead for many hours or days; impingement syndrome; an existing weakness of the rotator cuff muscles, ligaments or tendons; use of improper technique during a sport or occupational activity; poor posture; sleeping on the same arm each night; cervical spine nerve pinching; an improper training schedule, such as too much too soon; a direct trauma, such as a fall directly onto the shoulder or onto an outstretched arm; poor muscle control or coordination; poor posture over the years; or a loose or unstable shoulder joint following a previous dislocation. If the rotator cuff continues to be injured or inflamed it will eventually tear, resulting in a more serious problem.
The classic symptoms of rotator cuff tendonitis include a “toothache-like” pain that radiates down the outer arm to several inches below the top of the shoulder. Pain may also occur at the top and front of the shoulder. Initially, the pain may be mild and only occur with certain arm movements. Over time, pain is noticeable at rest and during the night. Sleep is interrupted due to a nagging upper arm pain. Activities requiring the raising of the arm overhead or those that require reaching behind the body usually aggravate the symptoms. The shoulder may feel stiff with lifting or movement.
The initial treatment traditionally used for rotator cuff tendonitis is frequently to limit above shoulder level activity, application of ice to the shoulder, anti-inflammatory medications for pain, and physical therapy to maintain flexibility.
Although common in the treatment of rotator cuff tendonitis, the use of anti-inflammatories and steroids may actually hinder the healing of tendons and ligaments, and unfortunately, do not address the root of the problem. Physical therapy is often an important part of recovery from these types of shoulder injuries, but if progress is not being made, and symptoms continue, it may be time to seek out regenerative treatments, since physical therapy is unable to address underlying degenerative issues such as fraying and tearing of the tendon.
Regenerative Orthopedics is recommended to regenerate and repair the soft tissues of the shoulder, plus it also strengthens the ligaments and the tendons of the rotator cuff and deltoid. This combined with the gradual re-strengthening of the rotator cuff muscles promises an excellent chance for a full recovery and full performance. In the event that surgery is truly necessary because a rotator cuff tear has become large enough to produce profound weakness in the shoulder, Regenerative Orthopedics is an excellent post-operative treatment to improve tissue strength and overall recovery.
The increase in blood flow and regenerative cells encouraged by this treatment is similar to the body’s natural healing response. The body also responds by depositing collagen at the site of injury, strengthening the rotator cuff tendons that once were weak, and resulting in the healing of the injured rotator cuff soft tissues.
Please contact us at OrthoRegen®, and tell us more about your case to determine if you are a good candidate for Comprehensive Regenerative Orthopedics.
OrthoRegen® is a full-time Regenerative Orthopedics office, with extensive experience in Stem Cell Therapy, PRP, and Prolotherapy. When it comes to Stem Cell Therapy, we use only the Gold Standard, which is so effective at repairing degenerated joints.