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Diagnosing, Treating, and Preventing Rotator Cuff Injuries
Dr. Casey Kiser leads a discussion of rotator cuff injuries.
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Learn more about Casey Kiser, MD
Casey Kiser, MD
Casey Kiser, MD is an Orthopaedic Surgeon.Learn more about Casey Kiser, MD
Transcription:
Bill Klaproth (Host): So, it happens to most of us, you go to reach for something and oh gosh, what is that pain in my shoulder? Yeah, could be your rotator cuff. So, let's talk about diagnosing, treating and preventing rotator cuff injuries with Dr. Casey Kiser, an Orthopedic Surgeon at UPMC West Shore Orthopedics with locations in Carlisle and Enola.
This is Healthier You, the podcast from UPMC in central Pennsylvania. I'm Bill Klaproth. Dr. Kiser, thank you so much for your time. We appreciate it. So, let's talk about our rotator cuffs. Here we go. So, what is the function of a rotator cuff? What is it and what does it do?
Casey Kiser, MD (Guest): Yeah, that's a great question. The rotator cuff is comprised of four muscles. So, the front is called the subscapularis. There's two in the back called the teres minor and the infraspinatus. And then there's one on the top the superspinatus, which is actually the most often injured. And together these four muscles kind of assist in stabilizing the shoulder joint. They keep the shoulder joint well reduced, and it's responsible for multi-directional movement of the arms. And initially kind of that initial phase of raising your arm in multiple planes and kind of helps keep the joint stable and in place.
Host: Wow. So, with four muscles, there is the opportunity for right over time for wear and tear or injuries to your rotator cuff. So, what happens when the rotator cuff is injured or compromised?
Dr. Kiser: Yeah. Great question. So, when these muscles and tendons are injured or overused, they can actually break down and kind of degenerate or sometimes even tear. Typically, what happens is you end up with pain and weakness with various shoulder motions, and specifically a lot of times there's complaints about overhead activities. You also can develop strains and inflammation of the rotator cuff which involve kind of irritation of the tendons themselves.
Host: Right. So, it sounds like there's multiple levels of rotator cuff injuries. What kinds of shoulder or rotator cuff disorders exist then?
Dr. Kiser: So, rotator cuff disorders kind of go from early inflammation all the way up to tear. So, inflammation of the tendons is also called tendonitis and that's where you actually get inflammatory response into the tendon itself. You could also have inflammation of the bursa. What the bursa is, it's a sack of fluid that's directly between the rotator cuff and the bones above it.
And those can get inflamed as well. You can also get what's called impingement, which the tendon is kind of squeezed and rubs against the two bones in the shoulder, the acromion and the humeral head and kind of rubs the rotator cuff and inflames it. There's also something called calcific tendonitis, which is where you build up calcium inside the tendon. And sometimes it can be very painful for people. Then the last kind of on the spectrum is when you develop a complete or partial tear of the rotator cuff tendon, and these are typically the most serious kind of aspect of tendon injuries of the rotator cuff.
Host: So, then who is at risk for these types of injuries and what are the common causes of a torn rotator cuff?
Dr. Kiser: Yeah. So, there's two different kind of age groups at risk for rotator cuff injuries. The younger patients are usually from either an acute injury, whether that's playing sports or a fall or a dislocation. Then the other patients are typically older patients where it's a little bit more wear and tear and degeneration over time. Those patients are usually, you know, 40 years old or greater. It's also more common in repetitive overhead activities with work, heavy lifting and then again, anytime trauma, falls, specifically puts you at higher risk.
In regards to rotator cuff tears, there's like I mentioned two different types the degenerative tears, again these are usually in older patients. These are progressive in nature and usually kind of have developed pain and weakness, that progressed over time and usually not any specific injury. Acute tears are from an injury, very common at dislocations. And then there's also two different types of tears, whether it's partial or complete. So, a partial tear is an incomplete tear in the tendon itself or incomplete tear off of the insertion on the humeral head. And then a complete tear or also known as a full thickness tear is when the tendon's completely torn, whether it's within the tendon itself or whether it's off of its attachment in the shoulder.
Host: Oh, my goodness. There is a lot. There was a lot that can happen in your shoulder and specifically your rotator cuff, holy cow. So, what are the symptoms that indicate an injury should be seen by a doctor? You know, we all kind of lift, overuse and our shoulder is sore and it's okay. At what point should we see the doctor?
Dr. Kiser: I think it's definitely recommended to see doctor if you've had a traumatic injury or a fall onto that shoulder, or to an outstretched hand, then you're having significant pain or significant weakness. Specifically, if you have a dislocation, especially in older patients, that's puts you at a significantly higher risk for a rotator cuff tear. Also I recommend being seen when you're unable to perform your everyday tasks or activities without pain or limitation. I mean, everyone wants to be able to do their normal activities without pain. And if this continues to happen, I definitely think it's worth being seen by a physician. Specifically pain and weakness are very common. So again, if those symptoms are common, it keeps you up at night. If you have difficulty doing your activities, I again recommend evaluation from either your primary care doctor or an orthopedic doctor.
When it's typically a strain, you're going to have stiffness, pain, limited mobility, and sometimes muscle spasms. And then with an overhead shoulder injury, you may feel pain that's concentrated in the shoulder region and worsening with movement. So, again, those are all kinds of symptoms that would probably warrant being seen by a specialist.
Host: So, with so much going on in the shoulder, as you've been telling us, it's a very complex joint. How is a rotator cuff injury then diagnosed?
Dr. Kiser: The first thing is just talking to the patient. And getting a history of the pain. So, was there an injury, was there a fall, was there a dislocation? How long has this been going on? Have you had shoulder injuries before? I see often the weekend warriors who injured their shoulder years ago, playing sports. So, that's very helpful. The second thing and actually very helpful in this is a physical exam. I'm able to test specific muscles and tendons to determine their strength. And the range of motion. And that can tell me quite a bit, just from a physical exam alone. Other ways we can diagnose this is with imaging studies. So, x-ray, MRI or ultrasound. X-rays are important. They don't always show a rotator cuff tear unless it's been going on for long time. But it can show us other signs of shoulder pain, including, you know, bone spurs, fractures, arthritis, which could be contributing to the issue.
But the best test to prove that there's a rotator cuff tear is an MRI, which we use you know the magnets to display the soft tissues in the structure. And that can be instrumental in determining if there is a rotator cuff tear.
Host: So then, with all of that, what are the treatment options for a rotator cuff injury?
Dr. Kiser: Yeah. So, treatment options vary quite a bit based on patient's age the acuity of the injury, the severity of the injury, patient's level of pain. So they can range anywhere from rest and isolation of the shoulder area to activity modification, just finding different ways to do your activities, to physical therapy, which could be helpful for strengthening and for range of motion.
Typical medications could be helpful, including anti-inflammatories and oral steroids to help ease the pain and decrease the inflammation. Heat and ice can be helpful, to kind of decrease some of the swelling and to help with some of the pain. But then we move into the more, a little bit more invasive treatment options including steroid injections. Again, those are placed directly over the rotator cuff tear. And again, this is very case dependent on whether it's beneficial and how often these can be done. And the last option is surgery and typically this is done with an arthroscopic rotator cuff repair. So, three or five little small incisions done, minimally invasive with the camera to repair that rotator cuff tendon back down to where it needs to go. Again, this is all determined on a case by case basis.
And then after surgery, usually you have to have a short course of immobilization then that up to six months of physical therapy to regain the motion and function. So, it's quite a long recovery for this type of injury.
Host: Right. But I guess the good news is with the different treatment options, people can regain generally full range of motion with their shoulder and be pain free. Is that correct?
Dr. Kiser: Absolutely. So, with rotator cuff tendonitis, or with even partial tear, rotator cuff tears, conservative treatment with injections, physical therapy, most people can get back to pain-free shoulder and all of their function. With surgery and most patients can get back to full function, full range of motion and a pain-free shoulder. So, there are good treatment options. But there's a lot of them do take some time and potentially a surgical intervention.
Host: Absolutely. So, then let's talk prevention now. What can people do to avoid suffering from a shoulder injury? I mean, we're using our arms all the time. How can we keep our shoulders healthy?
Dr. Kiser: One of my favorite mottos in life is no pain, no gain, but in this case that doesn't really work. So, what I always say to patients is if it hurts don't do it. So, find a different way to do it. So, pushing through the pain, whether it's with sports, whether it's with work or exercise in a gym; trying to do something to push through the pain is just aggravating the symptoms and propagating the inflammation. So, I recommend not trying to do that. I recommend using proper form when lifting or participating in activities. If you're lifting weights, tighten your core and focus on keeping your back. Get the load as close as possible to you. Keep your elbows and arms close to your body. Specifically when you're raising your arms, trying to raise weight with your arms extended puts a lot of stress on the rotator cuff, and that can kind of propagate an injury, or start an injury.
And then it's always important to stretch and warm up before you do anything, whether it's gym, whether it's going to work. Doing some basic shoulder motions to get things warmed up prior to jumping into it can be helpful for preventing injuries.
Host: Right. So, really good tips, Dr. Kiser, thank you so much for that. And this has really been informative. We kind of don't think about our shoulders until you go to reach up for that can in the cupboard like, oh boy, what's going on with my shoulder. So, this has really been informative and helpful. So thank you so much for your time. We appreciate it.
Dr. Kiser: Absolutely.
Host: And that's Dr. Casey Kiser. And for more information on UPMC West Shore Orthopedics, just call 717- 988-8135. Or visit upmc.com/centralPAortho. Once again, upmc.com/centralPAortho. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you.
This is Healthier You, a podcast from UPMC. I'm Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): So, it happens to most of us, you go to reach for something and oh gosh, what is that pain in my shoulder? Yeah, could be your rotator cuff. So, let's talk about diagnosing, treating and preventing rotator cuff injuries with Dr. Casey Kiser, an Orthopedic Surgeon at UPMC West Shore Orthopedics with locations in Carlisle and Enola.
This is Healthier You, the podcast from UPMC in central Pennsylvania. I'm Bill Klaproth. Dr. Kiser, thank you so much for your time. We appreciate it. So, let's talk about our rotator cuffs. Here we go. So, what is the function of a rotator cuff? What is it and what does it do?
Casey Kiser, MD (Guest): Yeah, that's a great question. The rotator cuff is comprised of four muscles. So, the front is called the subscapularis. There's two in the back called the teres minor and the infraspinatus. And then there's one on the top the superspinatus, which is actually the most often injured. And together these four muscles kind of assist in stabilizing the shoulder joint. They keep the shoulder joint well reduced, and it's responsible for multi-directional movement of the arms. And initially kind of that initial phase of raising your arm in multiple planes and kind of helps keep the joint stable and in place.
Host: Wow. So, with four muscles, there is the opportunity for right over time for wear and tear or injuries to your rotator cuff. So, what happens when the rotator cuff is injured or compromised?
Dr. Kiser: Yeah. Great question. So, when these muscles and tendons are injured or overused, they can actually break down and kind of degenerate or sometimes even tear. Typically, what happens is you end up with pain and weakness with various shoulder motions, and specifically a lot of times there's complaints about overhead activities. You also can develop strains and inflammation of the rotator cuff which involve kind of irritation of the tendons themselves.
Host: Right. So, it sounds like there's multiple levels of rotator cuff injuries. What kinds of shoulder or rotator cuff disorders exist then?
Dr. Kiser: So, rotator cuff disorders kind of go from early inflammation all the way up to tear. So, inflammation of the tendons is also called tendonitis and that's where you actually get inflammatory response into the tendon itself. You could also have inflammation of the bursa. What the bursa is, it's a sack of fluid that's directly between the rotator cuff and the bones above it.
And those can get inflamed as well. You can also get what's called impingement, which the tendon is kind of squeezed and rubs against the two bones in the shoulder, the acromion and the humeral head and kind of rubs the rotator cuff and inflames it. There's also something called calcific tendonitis, which is where you build up calcium inside the tendon. And sometimes it can be very painful for people. Then the last kind of on the spectrum is when you develop a complete or partial tear of the rotator cuff tendon, and these are typically the most serious kind of aspect of tendon injuries of the rotator cuff.
Host: So, then who is at risk for these types of injuries and what are the common causes of a torn rotator cuff?
Dr. Kiser: Yeah. So, there's two different kind of age groups at risk for rotator cuff injuries. The younger patients are usually from either an acute injury, whether that's playing sports or a fall or a dislocation. Then the other patients are typically older patients where it's a little bit more wear and tear and degeneration over time. Those patients are usually, you know, 40 years old or greater. It's also more common in repetitive overhead activities with work, heavy lifting and then again, anytime trauma, falls, specifically puts you at higher risk.
In regards to rotator cuff tears, there's like I mentioned two different types the degenerative tears, again these are usually in older patients. These are progressive in nature and usually kind of have developed pain and weakness, that progressed over time and usually not any specific injury. Acute tears are from an injury, very common at dislocations. And then there's also two different types of tears, whether it's partial or complete. So, a partial tear is an incomplete tear in the tendon itself or incomplete tear off of the insertion on the humeral head. And then a complete tear or also known as a full thickness tear is when the tendon's completely torn, whether it's within the tendon itself or whether it's off of its attachment in the shoulder.
Host: Oh, my goodness. There is a lot. There was a lot that can happen in your shoulder and specifically your rotator cuff, holy cow. So, what are the symptoms that indicate an injury should be seen by a doctor? You know, we all kind of lift, overuse and our shoulder is sore and it's okay. At what point should we see the doctor?
Dr. Kiser: I think it's definitely recommended to see doctor if you've had a traumatic injury or a fall onto that shoulder, or to an outstretched hand, then you're having significant pain or significant weakness. Specifically, if you have a dislocation, especially in older patients, that's puts you at a significantly higher risk for a rotator cuff tear. Also I recommend being seen when you're unable to perform your everyday tasks or activities without pain or limitation. I mean, everyone wants to be able to do their normal activities without pain. And if this continues to happen, I definitely think it's worth being seen by a physician. Specifically pain and weakness are very common. So again, if those symptoms are common, it keeps you up at night. If you have difficulty doing your activities, I again recommend evaluation from either your primary care doctor or an orthopedic doctor.
When it's typically a strain, you're going to have stiffness, pain, limited mobility, and sometimes muscle spasms. And then with an overhead shoulder injury, you may feel pain that's concentrated in the shoulder region and worsening with movement. So, again, those are all kinds of symptoms that would probably warrant being seen by a specialist.
Host: So, with so much going on in the shoulder, as you've been telling us, it's a very complex joint. How is a rotator cuff injury then diagnosed?
Dr. Kiser: The first thing is just talking to the patient. And getting a history of the pain. So, was there an injury, was there a fall, was there a dislocation? How long has this been going on? Have you had shoulder injuries before? I see often the weekend warriors who injured their shoulder years ago, playing sports. So, that's very helpful. The second thing and actually very helpful in this is a physical exam. I'm able to test specific muscles and tendons to determine their strength. And the range of motion. And that can tell me quite a bit, just from a physical exam alone. Other ways we can diagnose this is with imaging studies. So, x-ray, MRI or ultrasound. X-rays are important. They don't always show a rotator cuff tear unless it's been going on for long time. But it can show us other signs of shoulder pain, including, you know, bone spurs, fractures, arthritis, which could be contributing to the issue.
But the best test to prove that there's a rotator cuff tear is an MRI, which we use you know the magnets to display the soft tissues in the structure. And that can be instrumental in determining if there is a rotator cuff tear.
Host: So then, with all of that, what are the treatment options for a rotator cuff injury?
Dr. Kiser: Yeah. So, treatment options vary quite a bit based on patient's age the acuity of the injury, the severity of the injury, patient's level of pain. So they can range anywhere from rest and isolation of the shoulder area to activity modification, just finding different ways to do your activities, to physical therapy, which could be helpful for strengthening and for range of motion.
Typical medications could be helpful, including anti-inflammatories and oral steroids to help ease the pain and decrease the inflammation. Heat and ice can be helpful, to kind of decrease some of the swelling and to help with some of the pain. But then we move into the more, a little bit more invasive treatment options including steroid injections. Again, those are placed directly over the rotator cuff tear. And again, this is very case dependent on whether it's beneficial and how often these can be done. And the last option is surgery and typically this is done with an arthroscopic rotator cuff repair. So, three or five little small incisions done, minimally invasive with the camera to repair that rotator cuff tendon back down to where it needs to go. Again, this is all determined on a case by case basis.
And then after surgery, usually you have to have a short course of immobilization then that up to six months of physical therapy to regain the motion and function. So, it's quite a long recovery for this type of injury.
Host: Right. But I guess the good news is with the different treatment options, people can regain generally full range of motion with their shoulder and be pain free. Is that correct?
Dr. Kiser: Absolutely. So, with rotator cuff tendonitis, or with even partial tear, rotator cuff tears, conservative treatment with injections, physical therapy, most people can get back to pain-free shoulder and all of their function. With surgery and most patients can get back to full function, full range of motion and a pain-free shoulder. So, there are good treatment options. But there's a lot of them do take some time and potentially a surgical intervention.
Host: Absolutely. So, then let's talk prevention now. What can people do to avoid suffering from a shoulder injury? I mean, we're using our arms all the time. How can we keep our shoulders healthy?
Dr. Kiser: One of my favorite mottos in life is no pain, no gain, but in this case that doesn't really work. So, what I always say to patients is if it hurts don't do it. So, find a different way to do it. So, pushing through the pain, whether it's with sports, whether it's with work or exercise in a gym; trying to do something to push through the pain is just aggravating the symptoms and propagating the inflammation. So, I recommend not trying to do that. I recommend using proper form when lifting or participating in activities. If you're lifting weights, tighten your core and focus on keeping your back. Get the load as close as possible to you. Keep your elbows and arms close to your body. Specifically when you're raising your arms, trying to raise weight with your arms extended puts a lot of stress on the rotator cuff, and that can kind of propagate an injury, or start an injury.
And then it's always important to stretch and warm up before you do anything, whether it's gym, whether it's going to work. Doing some basic shoulder motions to get things warmed up prior to jumping into it can be helpful for preventing injuries.
Host: Right. So, really good tips, Dr. Kiser, thank you so much for that. And this has really been informative. We kind of don't think about our shoulders until you go to reach up for that can in the cupboard like, oh boy, what's going on with my shoulder. So, this has really been informative and helpful. So thank you so much for your time. We appreciate it.
Dr. Kiser: Absolutely.
Host: And that's Dr. Casey Kiser. And for more information on UPMC West Shore Orthopedics, just call 717- 988-8135. Or visit upmc.com/centralPAortho. Once again, upmc.com/centralPAortho. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you.
This is Healthier You, a podcast from UPMC. I'm Bill Klaproth. Thanks for listening.