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Rotator Cuff Repairs

Posted 6/25/2018 by UHBlog

Shoulder injuries can escalate if you ignore them. Talk to us about ways to manage and treat painful shoulder problems.

Male doctor shaking hands with patient on hospital bed

Do you wince in pain when you lift your arms and reach upward? While there are many factors that contribute to shoulder pain, rotator cuff problems are among the most common, especially in older athletes.

“Shoulder pain due to rotator cuff injuries are one of the most frequent complaints we see in people over age 50,” says orthopedic surgeon Robert Gillespie, MD. “As people age, their rotator cuff muscles and tendons thin out. The rotator cuff is like your favorite pair of pants – the more you wear them, the thinner they get.”

The rotator cuff consists of four muscles that help move and stabilize the shoulder. These muscles and surrounding tendons can become damaged or torn from:

  • An injury, such as a fall where you use your hand to cushion the fall
  • Chronic overuse. Sports that require a lot of overhead movement, such as pitching or throwing a baseball, hitting a tennis ball or spiking a volleyball, can lead to pain and problems.
  • A new workout and/or heavy weightlifting. CrossFit, TRX straps or routines where you swing kettlebells and weights overhead can put stress on the shoulders.
  • Improper warm-up and stretching. A good warm-up incorporates dynamic stretching prior to the workout and increases your heart rate and respiratory rate.
  • Gradual aging, which can lead to tissue degeneration

Whether you're a weekend warrior or a consistent athlete, injuries and/or pain often become your new normal the older you are. But with a rotator cuff injury, the longer you wait to treat it, the worse it can become. Over time, the pain can affect your quality of life.

“If you have pain that continues to wake you up at night, you have trouble doing normal activities of daily living or you're noticing increased difficulty with the sports you enjoy playing because of your shoulder, it may be time to see your physician,” he says.

After an exam, the usual treatment for rotator cuff pain is:

  • Rest
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Strengthening and stretching exercises
  • Ultrasound therapy
  • Corticosteroid injection

“If a patient still isn't doing well after conservative treatment that includes physical therapy, NSAIDs and possible injections, then we would order a magnetic resonance imaging (MRI),” Dr. Gillespie says. “But about 85 percent of the people we see never need an MRI.”

The next step might include minimally invasive treatments, one of which is arthroscopic surgery.

“With arthroscopic rotator cuff surgery, we make several small incisions around the shoulder and use state-of-the-art technology to reattach the rotator cuff to the bone,” he says. “My colleagues and I are continuing to push innovation and technology to better take care of our patients at University Hospitals, whether it's developing newer techniques for arthroscopic surgery or continuing to perform research to develop novel treatment strategies for the shoulder.”

If you have surgery, it can take five or six months before you’re back to playing sports again.

Patients have also tried platelet rich therapy (PRP). A centrifuge concentrates platelets from the patient’s own blood. Isolated platelets are then injected into the patient’s affected site to promote the healing process.

“Some patients ask us about stem cell therapy as a treatment option, but there isn't a lot of great evidence that this helps in the shoulder,” he says. “Stem cells need a 'carrier' with rotator cuff repair. The analogy I use is that it's like taking a balloon, filling it with water, then injecting that with stem cells. You can't be certain the stem cells necessarily go to the area in pain.”

With PRP – which is about one-sixth of the cost of stem cell therapy – the number of injections needed varies, but generally falls between two and six done over several visits.

Dr. Gillespie also recommends trying modalities such as acupuncture and yoga therapy, which are offered through University Hospitals Connor Integrative Health Network, as well as exercises done at home to strengthen your shoulders and improve shoulder flexibility.

“The [Connor Integrative Health Network] services are a hidden jewel for University Hospitals,” he says. “There is a real role for these modalities, which can be cutting-edge when dealing with shoulder pain, in addition to other musculoskeletal injuries.”

For shoulder strengthening tips, view University Hospitals Sports Medicine Healthy Tip #6: Overhead Injury Prevention.

Robert Gillespie, MD is an orthopaedic surgeon, chief of Shoulder and Elbow Surgery and associate program director, Orthopedic Surgery at University Hospitals Cleveland Medical Center. You can request an appointment with Dr. Gillespie or any other doctor online.

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