Treatment Options for Rotator Cuff Problems

After reaching the diagnosis of a problem with the rotator cuff, a medical provider may go over various treatment options, outlined below:

 

Activity Modification.  This means resting the shoulder and avoiding activities or positions that cause pain.  Avoid overhead reaching, or repetitious reaching or lifting.  Athletes who participate in overhead throwing or overhead sports (baseball/softbal, basketball, volleyball, dancing, etc) may need to rest from their sports for several weeks.  Side sleepers need to avoid pressure on their shoulder at night.  This is where The Shoulder Pillow is so beneficial.

 

Ice and Heat. Ice acts as a natural anti-inflammatory and reduces pain and swelling.  Most medical professionals recommend liberal use of ice, but care needs to be taken so as not to cause damage to the tissues.  Don’t ice for more than 20 minutes at a time and use a cloth material or other protection between the ice and the skin.  Using a heating pad will relax muscles and increase blood flow to the area.  Likewise, use caution to avoid burns.

 

Physical Therapy and Exercise. A good rotator cuff therapy program can improve strength and range of motion of the shoulder.  Specifically, strengthening of the other rotator cuff muscles can improve mechanics of the shoulder and decrease impingement of the supraspinatus tendon (pinching of the tendon between two bones, the humerus and the acromion).  Physical therapy can also treat or prevent stiffness of the shoulder and can help reduce inflammation.  Exercise is key to treating rotator cuff problems, but I caution patients that it does NOT mean simply “going to the gym” and/or “working out” your shoulder.  A misguided workout can be even more damaging to the rotator cuff.  A specific rotator cuff strengthening program needs to be closely followed and aggravating exercises need to be avoided.  There are many rotator cuff rehabilitation programs to be found online, or often formal therapy with a physical therapist is necessary.

 

Medications.  Anti-inflammatory medications can reduce pain and inflammation of the rotator cuff.  The most commonly recommended medications are Non-Steroidal Anti-Inflammatories (NSAIDs) such as ibuprofen or naprosyn.  These can be purchased over-the-counter and taken according to instructions on the packaging.  Caution is necessary because they can cause side effects, especially with long term or heavy use, and are NOT appropriate for people with certain medical conditions.  If in doubt, consult your physician.  Steroidal anti-inflammatories like prednisone are stronger anti-inflammatory medications, but carry more severe side effects.  These should only be used by prescription from your doctor and only for short periods of time for shoulder problems.

 

Injections.  Your medical provider may offer a corticosteriod injection for your shoulder.  This delivers the anti-inflammatory medication directly to the site of inflammation at the rotator cuff.  Usually pain is relieved within a few days.  Sometimes an injection can relieve pain on a long-term basis or permanently; other times, the pain can come back after a few days or weeks or months.  The efficacy of a cortisone injection is sometimes unpredictable and depends on the severity of the rotator cuff problem.  A cortisone injection can be repeated after a few months, but most doctors recommend against multiple injections, as side effects can become a problem.

 

Surgery.  When non-surgical treatments have failed and symptoms warrant further treatment, surgery is sometimes appropriate for rotator cuff problems.  If there is a complete tear or a high-grade partial tear of the rotator cuff tendon, it usually will not heal by itself.  Surgery is necessary in many cases to repair the tendon back to the bone.  Rotator cuff repairs are commonly done by orthopaedic surgeons with an arthroscopic procedure, using small incisions and a camera to repair the torn tendon. The repair can also be done with an open surgery.  Surgery is also sometimes indicated when there is no tendon tear.  Impingement (pinching) of the rotator cuff can cause pain and inflammation without a tear in the tendon.  An acromioplasty is a procedure where the bone (the acromion) is shaved to remove bone spurs or to provide more space for the rotator cuff and thus avoid impingement of the tendon.  To determine if surgery is necessary for any particular shoulder problem, consult your orthopaedic surgeon.

 

I hope this information is helpful if you have shoulder problems, and I hope The Shoulder Pillow will be helpful in relieving the pain you are experiencing.