By Rachel Jones | Photographs by Michael Fornataro
Talk of rotator cuff tears immediately takes our minds to the baseball field, where pitchers spend their careers extending their arms at close to 90 mph as many times as they can in one game. But the painful injury is experienced by other athletes, including hockey players and swimmers, and non-athletes as well, totaling 400,000 patients who needed repairs last year. “It’s exceedingly common,” says Bryson Lesniak, MD. As an orthopaedic surgeon at UPMC Sports Medicine, and the team physician for the men’s basketball teams at the University of Pittsburgh and Carnegie Mellon University, Lesniak himself works with 10-13 injured rotator cuffs per week.
The rotator cuff itself is a collection of muscles and tendons in the shoulder that allow stability and rotation. Most often, a rotator cuff injury occurs as a result of chronic overuse of these muscles, which also explains its prominent occurrence. Athletes who throw or swim, along with anyone who works with their arms above their heads for extended periods of time, can develop gradual wear, fray, and tearing of the tendons. “Eventually, it wears out to the point where it peels off the bone,” Lesniak says, “which may not be in one traumatic episode, but experienced as constant pain over time.” This contributes to “partial tears,” where the injury is caught before it fully tears off.
An evaluation of the patient’s core and lower extremity strength can help determine the root cause of the injury. “If they lack lower and core strength, they put more stress on the rotator cuff and shoulder,” says Rick Joreitz, PT, DPT, SCS, ATC. “Then, the snowball becomes an avalanche.” As a senior physical therapist at UPMC Sports Medicine and UPMC Centers for Rehab Services, Joreitz works with a lot of patients who receive rotator cuff tears after acute incidents of trauma or contact injuries, which is the second most common cause of the injury. For non-athletes, trauma could come from something minor like trying to catch themselves from a fall, or trying to start up the lawn mower after a long winter. “That’s a really common one,” Lesniak adds.
Treatment for the injury has greatly evolved over the years. Before the early ‘90s, rotator cuff tears were remedied with rounds of physical therapy, ice, and anti-inflammatories. If the injury persisted, surgery was a final option. “As results have gotten better and down-time after surgery has gotten shorter, surgery is offered more frequently and sooner,” Lesniak says. “People do benefit from therapy, but the pendulum has swung toward treating with surgery.” The surgical technique has improved, too, taking an arthroscopic route that requires a smaller incision, is minimally invasive, and yields faster recoveries.
Joreitz works with the patients in recovery for four to eight weeks, getting the shoulder back to its normal rotations and strengthening the scapula stabilizers to prevent a future injury. “Your outcomes are different and the goal of therapy is different when it’s [a non-athlete] compared to a thrower,” he says. “The regular population is just trying to get back to daily activities and be strong enough to prevent additional injury, but a thrower needs to be strong enough to throw again and not have any set backs.”
When the Pittsburgh Pirates experience rotator cuff pain, Head Athletic Trainer Todd Tomczyk executes a program that emphasizes range of motion, flexibility, rotator cuff and scapula strength, posture, and dynamic stabilization, and also factors in the time of the season, level of play, and type of injury. “Shoulder exercises commonly focus on restoration of motion, joint mechanics, motor programming and strength, and stabilization exercises,” he says. “This process helps address each of these components to allow individuals to return to normal, and hopefully pain-free, function of the shoulder without surgery.”
And in terms of preventing an injury from occurring in the first place? “There’s not a lot you can do,” Lesniak concludes. Throwing athletes, particularly pitchers and catchers, and anyone who frequently completes overhead activities and experiences shoulder pain, can do physical therapy to strengthen the cuff and joints around it. The tear may not be reversed, but the alleviation of symptoms and prevention of them worsening will make an incredible difference.
“When you’re an athlete, though, injuries happen,” Lesniak says. “But look at the advantages of being active, despite these risks, compared to being inactive. It’s not a good tradeoff. We like our patients to be active and get back to being active.”
UPMC Sports Medicine, UPMCSportsMedicine.com.