Steroid Shots or Physical Therapy? The Best Treatment for Rotator Cuff Pain

Steroid Shots or Physical Therapy? The Best Treatment for Rotator Cuff Pain Blog

Chronic shoulder pain from rotator cuff tendinosis is difficult to ignore, and it may keep you from performing even the most basic tasks. The longer it goes on, the more it interferes with your quality of life, making it difficult to carry out simple activities of daily living that you once took for granted. In an effort to find relief, you may go to a specialist who recommends corticosteroid shots to reduce inflammation and ease pain. However, the efficacy of steroid shots to relieve rotator cuff pain is highly contested.

What the Research Tells Us about Corticosteroid Treatment for Rotator Cuff Pain

In a recent meta-analysis published in “Clinical Orthopaedics and Related Research,” Mohamadi et al. reviewed the outcomes of 11 different studies about the efficacy of corticosteroid injections in relieving rotator cuff pain. All were randomized controlled trials that compared corticosteroids injections to placebo injections in 726 patients suffering from rotator cuff tendinosis.

The Researchers Concluded:

● Only one in five of the patients in the corticosteroid group reported minor transient pain relief within two months of injection.
● Pain relief did not improve with additional injections.
● Corticosteroid injections can cause harm to the tendon of the rotator cuff
● Injections are painful to patients and not particularly efficacious
● Seeking relief through steroid shots may cause patients to postpone treatment that may be more effective in reducing rotator cuff pain.

Causes of Rotator Cuff Tendinosis

Even if shots do have a modicum of success in alleviating your pain, they may be masking a disorder that needs to be addressed before it becomes worse. Rotator cuff tendinosis may have multiple common causes:

● Aging may make you more vulnerable to rotator cuff injury, and reduce your capacity for tissue repair and healing.
● Repetitive overuse of rotator cuff muscles, caused by doing the same motion over and over again, for example, serving a tennis ball, can lead to tendinosis.
● Poor postural habits like slumping forward can narrow soft tissue space, causing abrasion and reducing blood flow to the muscles and tendons.
● Muscle fatigue from inadequate recovery can lead to poor movement mechanics and internal damage.
● Shoulder posterior capsule tightness may cause the ball of the shoulder to press upward into the socket, leading to abrasion of the rotator cuff muscles and tendons.
● Shoulder instability due to connective tissue laxity or deconditioned muscles may lead to impingement of the rotator cuff on the acromion bone.

Physical Therapy Treatment for Rotator Cuff Tendinosis

The physical therapy team at NYDNRehab in NYC can guide you through a series of stretching and strengthening exercises that will eventually eliminate the underlying cause of your rotator cuff pain altogether, and restore full functionality to your shoulder girdle.

Physical Therapy Treatment may Include:

● Rest and cryotherapy to promote tissue healing
● Stretching the muscles of the shoulder capsule to restore flexibility
● Strengthening the rotator cuff muscles after they have had sufficient recovery
● Exercises to promote healthy postural habits
● Gradual return to sport or return to work strategies for activities requiring repetitive shoulder movement

Once physical therapy has been undertaken and your shoulder is restored to full functionality, it is up to you to take measures to maintain shoulder health. Reverting to physical inactivity, muscle overuse activities without adequate recovery and poor postural habits can undermine the benefits of physical therapy. To remain pain-free in the long run, a regular balanced exercise program with adequate rest and recovery between exercise sessions should be undertaken.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

image

Complete tear of rectus femoris
with large hematoma (blood)

image

Separation of muscle ends due to tear elicited
on dynamic sonography examination

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