Rotator Cuff Injury Treatment

About treatment

The soft tissues that make up your rotator cuff are involved to a lesser or greater extent in all types of human movement. The four sets of muscles and tendons enable you to freely lift, lower and rotate your arms in all 3 planes of motion, so you can perform a plethora of everyday tasks with ease. In sports, a strong and flexible rotator cuff is essential for skills performance and injury prevention. Rotator cuff injuries can be very painful and debilitating, requiring case-specific individualized therapy for every patient.

Dr. Lev Kalika

Clinical director & DC RMSK

About Shoulder Blade Pain
Specialist Dr. Lev Kalika

Dr. Kalika, clinical director of NYDNRehab, has devoted his life’s work to finding innovative and effective ways to treat musculoskeletal pain and dysfunction. Dr. Kalika has published multiple scientific articles on the use of musculoskeletal ultrasonography in rehabilitative medicine. He has developed his own holistic methodology for diagnosing shoulder and rotator cuff pain with the use of high-resolution ultrasound imaging.

According to Dr. Kalika, shoulder pain is too often mismanaged, focusing on the rotator cuff while ignoring the scapula. Physical therapy is most effective when the structural integrity of scapular muscles and nerves is restored, and regenerative therapies for rotator cuff tendons yield only mediocre results if the shoulder girdle/neck complex is not addressed holistically. His diagnostic approach includes a dynamic exam of the shoulder and scapular muscles using motion analysis and ultrasound imaging.

Dr. Kalika is at the forefront of pioneering work on fascia, the connective tissue that encases and connects muscles and organs throughout the body. Fascia plays an important role in stabilizing the shoulder joint, permitting nerves and blood vessels to glide freely among other structures. Dr. Kalka uses high-resolution ultrasound to visualize fascia connections that affect shoulder function. He is certified in the Stecco method of fascia manipulation, an approach that targets fascia densifications that impede shoulder movement.

Dr. Kalika studied directly under Dr. Ben Kibler, world-renowned orthopedic surgeon and pioneer of scapular dyskinesis. His diagnostic approach focuses on the structural integrity of the scapular muscles, and the nerves that innervate the shoulder complex. He addresses these issues with extracorporeal regenerative therapies and regenerative injection therapies.

Dr. Kalika was among the first in his field to become certified in dynamic neuromuscular stabilization (DNS), the most integrative evidence-based approach for treating shoulder pain. He was mentored directly by the creator of DNS, Dr. Pavel Kolar. His expertise in treating athletic rotator cuff injuries is unsurpassed in NYC.

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Anatomy and Function of the Rotator Cuff

Your rotator cuff is formed by a group of four muscles and their tendons. They originate at your scapula, aka shoulder blade, and wrap around your glenohumeral joint, or shoulder.

The internal rotators, supraspinatus and subscapularis

— run across the top and the front of the humeral head, respectively, and allow you to rotate your shoulder forward and inward.

The external rotators, infraspinatus and the teres minor

— run across the back of the humeral head and allow you to raise your arm overhead and rotate your shoulder outward.

The muscles are anchored to the head of your humerous by tough tendons that stabilize the shoulder joint and hold the humerus in place within the glenoid fossa. The rotator cuff complex is protected by bursae in each shoulder, to prevent the soft tissues from rubbing against bone.

Your rotator cuff enables you to execute finely tuned upper body movements. This is particularly important in sports like tennis, baseball, swimming and football, where precise shoulder movement is critical for elite skills execution.

Sports Where Rotator Cuff Injuries are Common

All sports have inherent risks, but certain sports have a higher incidence of rotator cuff injuries:

Contact sports like football, rugby and ice hockey
Sports requiring repetitive overhead motions like baseball, tennis, golf, swimming and basketball
Sports that overload the shoulder complex, like dance, gymnastics, pole vaulting, javelin and shot put

Athletes should not ignore rotator cuff pain, as injuries may worsen over time. Early diagnosis and treatment are key to successful recovery and return to play.

Types of Rotator Cuff Ruptures

Rotator cuff tears are often categorized by origin and degree. While there are many subcategories of tearing, the four main types seen most in our clinic include:

Full-thickness tears

The worst kind of rupture, a complete tear splits the soft tissue into two separate pieces, or detaches the tendon from the bone. In the worst cases, the tendon cannot be fully repaired, and function is only partially restored.

Partial thickness tears

Partial thickness rotator cuff tears (PTRCTs) are graded by the length of the tear, with tears less than 3mm being grade 1, tears 3mm to 6mm being grade 2, and tears greater than 6mm being grade 3. PTRCTs are further categorized by location:

Articular-sided PTRCTs

— occur near the joint. They are the most common type of PTRCT, and are frequently seen in overhead athletes like tennis and baseball players, and in swimmers.

Bursal-sided PTRCTs

— are less common and generally seen in patients over 40.

Intrasubstance PTRCTs

— also called interstitial tears, can occur in isolation within the tendon, or in conjunction with articular- or bursal-sided tears

Other factors that play into categorization of PTRCTs are tissue quality, direction of tearing (anterior-posterior or medial-lateral), and the etiology (cause) of the tear.

Rotator Cuff Injury Diagnosis

The complexity of the shoulder region makes it challenging to accurately diagnose the exact source of pain. A clinical exam with testing for strength and range of motion helps us narrow it down, but imaging is necessary to get an accurate diagnosis

At NYDNRehab, we use the highest-resolution ultrasound equipment available, to view damage to the rotator cuff in real time. Ultrasound lets us view the injured area with the patient in motion, so we don’t miss a thing. We also use sonoelastography to gauge muscle and tendon stiffness, and superior microvascular imaging to detect early signs of healing.

Treatment of Rotator Cuff Injuries

Conventional treatment for rotator cuff injuries often involves rest, anti-inflammatory drugs, NSAIDs, physical therapy exercises, steroid injections and surgery. However, conventional approaches often fall short of restoring full function, especially for athletes.

At NYDNRehab, we use advanced technologies and therapies that eliminate the underlying causes of pain and injury, to restore the rotator cuff and shoulder joint to fluid pain-free function.

Our treatment toolbox includes

ESWT (extracorporeal shock wave therapy) to accelerate healing

Biomechanical analysis and retraining to restore functional movement

Kineo Intelligent Load testing and AI feedback retraining

Proteus Motion system for multiplanar coordinated movement

C.A.R.E.N virtual reality feedback training

DNS (dynamic neuromuscular stabilization) to restore innate motor patterns

Our team of sports medicine professionals develops individual treatment protocols for each patient, based on their type, origin and severity of injury. Our high-tech feedback systems ensure that your brain and muscles are fully recovered before we release you to return to sports or other regular activities.

Clinical Case Studies
NYDNRehab

Ultrasound-Guided Dry Needling Eliminates Joint Fluid, Corrects Posture and Alleviates Mechanical Overload

Our patient was a 40-year-old female with bilateral knee hydrarthrosis (fluid accumulation) and shoulder impingement, who was suspected to have arthritis.

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Neck and Shoulder Pain Diagnosis and Treatment with Ultrasound-Guided Dry Needling

Our patient was a 46 year-old male complaining of pain in his left shoulder and neck. During the clinical exam, it was revealed that two days prior, he had received an allergy injection in his left arm for asthma.

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Ultrasound Guided Dry Needling for Chemotherapy-Induced Pain and Numbness

Our patient is a 43 year-old female suffering from hand numbness and impingement of the right shoulder consequent to chemotherapy treatment for thymoma.

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Lev Kalika Clinical Director and DC, RMSK

Dr.Kalika has revolutionized rotator cuff injury and shoulder pain treatment by using high resolution diagnostic ultrasonography for structural diagnosis, combined with gait and motion analysis technology. The NYDNRehab motion and gait analysis lab is the only private lab in the US to feature research-grade technologies found only in the world’s top research labs, and made available to patients in our private clinic. Dr.Kalika’s modern approach to shoulder injuries has put him on the radar of some of the world’s top distance runners, pro athletes and professional ballet dancers.