Posted December 28, 2016 by FIT Physical Therapy
The “rotator cuff” is a group of 4 muscles and their tendons (which attach them to the bone). These muscles connect the upper-arm bone, or humerus, to the scapula or shoulder blade. The rotator cuff functions to move the arm in many directions and also stabilizes the shoulder joint.
Unfortunately, injuries to the rotator cuff are very common, either from injury or with repeated overuse of the shoulder. Injuries to the rotator cuff can vary as a person ages. Rotator cuff tears are more common later in life, but they also can occur in younger people. Athletes and heavy laborers are commonly affected. Older adults also can injure the rotator cuff when they fall or strain the shoulder. When left untreated, this injury can cause severe pain and a decrease in the ability to use the arm.
Sometimes, the rotator cuff becomes inflamed or irritated due to heavy lifting, repetitive arm movements, or a fall. This condition is called Rotator Cuff Tendonitis and often responds well to rest, ice, anti-inflammatory medication, and physical therapy.
A rotator cuff tear is a more serious problem when injuries to the muscles or tendons cause tissue damage or disruption.
Rotator cuff tears are called either “full-thickness” or partial-thickness,” depending on how severe they are. To diagnosis if you have rotator cuff problems, your health care provider will review your health history, perform a thorough examination, and conduct a series of tests designed specifically to help pinpoint the cause of your shoulder pain.
In some cases, the results of these tests might indicate the need for a referral to a specialist or for imaging tests, such as an MRI.
Once a rotator cuff injury has been diagnosed, you will work with your orthopedist and physical therapist to decide if you should have surgery or if you can try to manage your symptoms with conservative treatment. If you don’t have surgery, your physical therapist will work with you to restore your range of motion, muscle strength, and coordination, so that you can return to your regular activities. In some cases, your therapist may help you learn to modify your physical activity so that you put less stress on your shoulder.
If a significant rotator cuff tear develops, you will most likely need surgery to restore use of the shoulder or decrease painful symptoms. After the surgical repair, you will need to wear a sling to keep your shoulder and arm protected as the repair heals. The repaired rotator cuff is vulnerable to re-injury following shoulder surgery, so it’s important to work with a physical therapist to safely regain full use of the injured arm. Once you are able to remove the sling for exercise, the physical therapist will begin your exercise program.
Your treatment program will include gentle range-of-motion and strengthening exercises designed to restore movement, strength and function to your shoulder and arm. The rehab of a rotator cuff tear can at times be quite painful. It takes the combination of a skilled therapist, and a determined patient to get the very best results after surgery.
The timeline for recovery will vary depending on the surgical procedure and your general state of health, but full return to sports, heavy lifting, and other strenuous activities might not begin until 4 months after surgery.
Darren Marchant, PT,MSPT,OCS
FIT Physical Therapy
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Posted September 21, 2016 by FIT Physical Therapy
It seems logical that when we feel pain somewhere in our body, it is because something is not right in that same area. For example, you smash your finger with a hammer, it is your finger that hurts, not your foot. However, there are some physical maladies that do not follow that logical conclusion and can be a bit perplexing. Cervical radiculopathy is one such condition.
Cervical radiculopathy is often referred to as a pinched nerve in the neck. It is characterized by radiating pain from the neck to the shoulder, shoulder blade, arm, or hand. Weakness and lack of coordination in the arm and hand can also occur. The condition affects an average of 85 out of 100,000 people—most often individuals in their 50’s. Athletes, heavy laborers, and workers who use vibrating machinery are commonly affected. People who sit for long periods of time, or individuals with arthritis in the cervical (neck) region can also be affected.
Cervical radiculopathy occurs when a nerve root coming off the spinal cord becomes compressed. The compression can occur for various reasons. In younger people, it may occur when a cervical disc herniates due to trauma. In older individuals, it commonly occurs seemingly out of nowhere but is a result of arthritis or decreased disc height in the neck region.
The cervical spine consists of 7 cervical vertebrae (the bones that form the neck region). Each vertebra is separated by a gel-like disc. The discs provide shock absorption for the spine. The spinal cord travels through a canal in the cervical vertebrae. Spinal nerve roots extend from the spinal cord and branch off going to specific locations in the arm. The spinal nerves send signals to our muscles for movement as well as sensations that we feel in the entire arm. The spinal cord is like a tree trunk, and the spinal nerves are like the tree branches. If an impingement or abnormal pressure is placed on a branch near the trunk, everything along that branch will be affected.
When the spinal nerves are impinged, they cannot properly send messages to the muscles from the brain, nor receive proper sensation from the specific arm location the nerve travels. Everywhere the spinal nerve travels will be affected. That is why a pinched nerve in the neck can cause pain, weakness, and loss of sensation in the arm or hand.
Symptoms of cervical radiculopathy vary depending on the nerve root involved, and commonly occur on the same side of the body as the affected nerve. The symptoms may include:
These symptoms may also be specific to the nerve root involved. The most common nerve root levels for this condition are C6 and C7.
Most cases are best treated conservatively. If you feel you may have this condition, consult your doctor. Often they will refer you to a physical therapist. In physical therapy we use treatments such as hot and cold packs, electrical stimulation to calm the nerve pain and manual therapy techniques such as cervical traction to relieve the pressure in the neck region. We also focus on gentle stretching and strengthening exercises as well as postural education and a home exercise program to reduce neck stress and fatigue and prevent re-occurrence.
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