The Injury
rotator_1The rotator cuff is a group of four muscles and their tendon attachments that surround the shoulder joint. These tendons attach to the ball of the shoulder (humeral head) and act as the inner “ball bearing” stabilizers of the joint. The rotator cuff needs to be functioning properly for the outer layer of large muscles to do their job. The muscles that comprise the rotator cuff are the supraspinatous, which elevates the shoulder, the subscapularis which internally rotates the shoulder, and the infraspinatous and teres minor which are the external rotators. The supraspinatous is the one most commonly involved in injury.

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Rotator Cuff Injuries
rotator_2Pinching, or impingement of the rotator cuff can occur against the overlying bone called the acromion. This can occur due to a spur on the acromion, or a thickening or curvature of this bone which rubs against the tendon. This results in inflammation of the tendon (rotator cuff tendinitis) and its adjacent lubricating sac, the bursa (bursitis). If the impingement persists for extended periods, actual tearing of the rotator cuff tendons may occur. X-rays are usually necessary to confirm the presence of a special spur. Tearing of the tendon can best be detected with a special type of x-ray called an MRI (Magnetic Resonance Imaging).

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Symptoms
Aching pain on the side of the upper arm is the most common complaint. Pain is often worse at night, and with any attempts at overhead activities. Throwing, tennis and weight lifting are particularly painful. There may be some clicking in the shoulder due to thickening of the inflamed bursa. Weakness suggests that the rotator cuff may be torn.

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Treatment Options
70% of patients will improve with non-surgical care. Initial treatment involves anti-inflammatory medication, ice, avoiding over shoulder reaching and lifting activities. In the very acute painful phase exercises are avoided. When pain subsides somewhat, rotator cuff exercises are begun. The primary goal of the exercises is to work the uninjured portion of the rotator cuff. This is accomplished by emphasizing internal and external rotation exercises using an elastic tubing. Scapula stabilizers are also strengthened. Deep tissue work by a physical therapist can help relieve associated spasm. Isolated strengthening of the most commonly injured supraspinatous tendon should be avoided. If there is no response to this treatment program, an injection of cortisone is provided. Cortisone is a strong anti-inflammatory medication that, when used appropriately and sparingly, is safe and can be dramatically beneficial.

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Surgery
If there is no response to conservative care for a minimum of three months, surgery is discussed. The purpose of the surgery is to remove the bone spur from the acromion. This surgery is performed arthroscopically using 3 small puncture holes in the shoulder. If the tendon is found to be torn, repair can now also be performed arthroscopically, avoiding an incision in most cases. All surgery is performed as an outpatient and typically takes one hour.

Dr. Halbrect has recently invented a new device which allows a simplified method for Arthroscopic Rotator Cuff Repair using the Versalok rotator cuff device.

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Rotator Cuff Repair Using Latest Techniques.
Jeff Halbrecht MD San Francsico. Versalok TV Segment

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After-care
Following surgery a sling is worn for one day and range of motion exercises are begun. The amount of activity allowed depends on the severity of the injury to the rotator cuff.

Prepare for your Arthroscopic Shoulder Surgery

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Prognosis
90% of patients achieve a good/excellent result following surgery and are able to return to full activities.

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Weight lifting & Rotator Cuff
Weight lifting is a common cause of rotator cuff injuries. Many lifting exercises can be modified so as to protect the rotator cuff and avoid reinjury. The basic concept is to avoid positions which will impinge the tendons. A practical way to approach this is to draw an imaginary box which extends from your chin to your hips and is shoulder wide. Modify your lifting program so that your hands stay within this box. For example, do your pull downs in front of your body rather than behind your head. Avoid flys. Instead, use the nautilus pec machine with the range of motion restricted to avoid excessive hyperextension of the shoulder. Do the bench press in a more limited arc so that your elbows never break the imaginary plane (don’t let the elbows extend behind your body). An additional pearl. Do pull ups and other similar exercises with your palms facing towards your face. This places your shoulders in external rotation moving the most vulnerable portion of the rotator cuff out of the way of the acromion.

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“ Love Dr. H. He did my knee last year and it went beautifully. He is very knowledgeable and very kind and an excellent surgeon. Just went for my shoulder--worked out great! Highly recommend him. ”

— Babyboomer Z. | San Francisco, CA

“ Once you get in to meet him... the experience is great! He's super friendly, knowledgeable and knows how to talk to patients when explaining the complexities of the problem. ”

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“ Six months ago, after my last surgery with the other surgeon failed, I got in to see Dr. Halbrecht right away, and was able to schedule surgery the following week! My shoulder is soooo much better now! I feel like my nightmare is over. ”

— Kristen M. | San Francisco, CA