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.

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.

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.