Both Marvel and Menace

By Roger Harward, PT

We can do marvelous things because of our shoulders. We can reach high above our head or behind our backs. We can write, work at the computer, or paint a ceiling. We can drive a golf ball hundreds of yards, propel ourselves through water, smash a tennis serve, and even throw a fastball ninety plus miles per hour. Truly marvelous.

We can do these things because of the way our shoulder is designed. Most people think of the shoulder as being a simple ball and socket joint. The shoulder is actually a complex joint consisting of three bones (scapula, clavicle, and humerus) and a myriad of ligaments, tendons, and muscles integrating together to function during demanding tasks.

The shoulder functions in a constant balance between mobility and stability. It must be loose enough to allow our arms to move in many directions, yet it must also provide power and stability. It is the four muscles called the rotator cuff along with the scapular muscles working in coordination with the our big power muscles that provide both mobility and stability; quite a task. Consider the mechanics of the shoulder during the overhead fastball pitch. The shoulder joint has been measured to rotate at an amazing four thousand degrees per second. The rotator cuff must assist in generating rotational power while stabilizing so the ball stays centered in the socket. These same demands, though of less intensity, come into play during the golf swing, tennis serve, and even simple daily tasks. Add to this the fact that we perform these tasks repetitively throughout our day, every day. Amazing.

While the shoulder is indeed a marvel, it can easily be injured and cause pain. Common disorders that can affect the shoulder, besides fractures and dislocation, are inflammations such as bursitis, frozen shoulder, and osteoarthritis. Some of the most common shoulder problems involve the rotator cuff.

Rotator cuff disorders can range from minor tendonitis to partial or full thickness tears. They can develop suddenly (acute-traumatic) or more commonly, as a slow wearing of the cuff over time (chronicdegenerative). Rotator cuff problems can be painful, usually at night, and weakness may be present with difficulty raising the arm overhead.

In spite of potentially being very painful, rotator cuff problems are not emergent. Thus, people may be inclined to avoid seeking medical attention because they fear surgery is their only option. However, it is wise to see a medical professional with understanding of shoulder conditions to get proper diagnosis and treatment. Rotator cuff pathologies, if left untreated, can progress and become more difficult to manage over time.

The truth of the matter is that many rotator cuff problems can be managed without surgery. This may include medications, corticosteroid injections, and physical therapy. Two recent studies found that certain types of rotator cuff tears can be successfully treated with physical therapy. A study from Finland (Kukkonen J, et. al., Bone Joint J. 2014 Jan; 96 -B) found that physical therapy produced results equal to those produced by surgery in patients with atraumatic rotator cuff tears. Another highly regarded study published in Journal of Shoulder and Elbow Surgery, Volume 22, Issue 10 by John E. Kuhn, MD, et al. found that non operative treatment using supervised physical therapy is effective for treating atraumatic rotator cuff tears in approximately 75% of patients who were
followed up for two years.

It is important to note that not all rotator cuff problems are the same, and conservative management may be unsuccessful. Numerous factors determine successful treatment such as tear size, tendon and muscle quality, and patient health factors. This is why it is important to seek the advice of medical professionals that understand shoulder conditions. In some cases, surgery may be best option. The good news is that many rotator cuff problems can be solved without surgery. But if needed, surgery has proven to have very good outcomes with over 80 percent of patients reporting being very satisfied with the results.