The rotator cuff is a powerful tram of muscles and connecting tendons.  These muscles and tendons attach your upper arm to your shoulder blade.  Your rotator cuff helps you reach, throw, push, pull, and lift.  Without it, your shoulder would be nearly useless.  A rotator cuff may be injured, but they can heal.  

Why your Shoulder Hurts
Your shoulder probably hurts because your rotator cuff tendons are swollen or damaged.  this could be caused by many things.  Maybe you fell on your shoulder or strained it by doing too much reaching or lifting.  Maybe you threw one too many pitches.  Or maybe you twisted your shoulder during exercise class.  Even such things as working in the yard or cleaning a closet could have triggered your pain.   And the older you get, the weaker your muscles and tendons become.  This means they are more easily injured.

How Your Shoulder Heals
What can you and your doctor do to stop the pain and get your shoulder back back?   First your condition is evaluated.  You and your doctor will then plan the best way to reduce your pain and heal your rotator cuff.  Depending on your injury, your treatment may involve nonsurgical care, surgical care, or both.  In any case, follow-up exercises and learning to move correctly are needed for your rehabilitation (rehab).

Your Shoulder's Active Anchor
You may not have thought much about your shoulder until your rotator cuff started to hurt.  Now you realize what a healthy rotator cuff allows you to do.  With a strong rotator cuff, your shoulder is a master of motion.  When your rotator cuff is damaged, even simple movements can be painful.

Overuse tendinitis
Shoulder motions used during activities like golfing, pitching, or carrying luggage may cause repetitive stress within the rotator cuff.  This can lead to irritation, bruising, or fraying.  Any of these can cause shoulder pain and weakness in the joint.

When Your Cuff's Had Enough
Pain told you that something was wrong with your shoulder.  Now that you know it's a rotator cuff problem, you may wonder what caused it.  Rotator cuff tendons can become damaged or inflamed (tendinitis) in many ways.  These include irritation (overuse), pinching (impingement), calcium deposits (calcification), and splitting (tears).  Any of these condition can make your shoulder weak, tender, and painful.

Impingement Tendinitis
The acromion can pinch (impinge) and irritate the rotator cuff when the space between them narrows.  This can happen when the cuff is weak, the bursa is swollen, or the acromion angles down too far.  Impingement tendinitis can occur with repetitive shoulder activities.  These include sports or jobs involving overhead reaching.

Calcification tendinitis
Inflammation can led to calcium deposits within the rotator cuff.  This can cause pain and a loss of shoulder strength and movement.

Tears
Severe tendinitis can cause partial or complete tearing of the rotator cuff.  This can result in shoulder pain, weakness, and a loss of normal movements.

Evaluating Your Injury
Before your rotator cuff problem can be treated, Dr. Kalbac needs to assess your injury.  This means taking a look at your health history and daily activities.   A shoulder exam and test help pinpoint the cause and type of your injury.   Then you and Dr. Kalbac can talk about the treatment plan that's best you.

Your Health History
To learn about injury, Dr. Kalbac may ask you many questions.  Where do you feel pain?  When do you feel pain?  How is it affecting your activities?   What kind of job or sports are you doing?  Dr. kalbac may also ask about any other physical problems you've had.  You may also be asked about any family health problems that might affect your treatment.

Your Shoulder Exam
To find the location and cause of your pain, Dr. Kalbac will feel your shoulder.   He may also check for signs of weakness and for any popping or grinding sounds.   Movement and resistance tests help show your shoulder's flexibility, strength, and stability.

Arthrograms
Dye is injected into your shoulder joint to outline the rotator cuff.  If the cuff is torn, dye leaks into the area outside the cuff.  This will show on this type of x-ray.

Magnetic Resonance Imaging(MRI)
Cross-sectional images provide views of rotator cuff problems.  These can include inflammation, tears, and calcium deposits.

Easing Your Pain
Care for your injury will most likely begin with nonsurgical treatments ranging from simple rest to pain-soothing injections.  Dr. Kalbac will tell you how often you may need these treatments.. If the treatments relieve your pain, you will be given an exercise program to restore your shoulder's power.  If your pain just won't quit, you and your doctor may decide you need surgery.

Rest
Rest your shoulder by keeping it still.  You may be given a sling to support your arm.  When sitting or lying down, try to keep a pillow between your arm and your side.  Because total inactivity can cause stiff joints, it helps to do some gentle stretching exercises.

Cold and Heat
Putting ice on your shoulder can help reduce inflammation and pain.  Use a cold pack, a bag of frozen peas, or a towel filled with ice cubes for 15 to 20 minutes at a time.  Alternating heat with cold can also soothe your pain.  Try warm showers, hot packs, or a heating pad that uses moist heat.

Medication
To help relieve your pain and inflammation, Dr. Kalbac may suggest that you take an oral ant-inflammatory medicine such as aspirin or ibuprofen.  Dr. Kalbac will tell you how much you need.

Electrical Stimulation
Electrical stimulation of muscles and nerves may decrease severe, constant pain and inflammation.  Methods such as interferential nerve stimulation use electrical impulses to block the pain signals coming from your shoulder.

Injections
If your pain is severe, Dr. Kalbac may inject cortisone near the inflamed area.   This helps reduce inflammation and pain.  Anesthetics may also be used to control your pain.

Moving Into Fitness

Whether you have surgery or not, your ideal recovery depends on restoring you shoulder's function.  To build and maintain flexibility and strength, you need to exercise your rotator cuff muscles during recovery and in the future.  Dr. Kalbac or   your physical therapist will tell you which exercises you need to do.  You'll also be told how often to do them and where to get tubing or hand weights.

To prevent injury, always stretch before and after you do the strengthening exercises.   Stop any exercise that causes pain, and discuss it with Dr. Kalbac or your physical therapist.

Understanding Surgery

If your injury doesn't improve with other treatments, Dr. kalbac may suggest surgery.   Rotator cuff surgery can treat impingement's, calcium deposits, or complete tears.   Depending on your injury, you may need to stay overnight at the hospital or surgery center.  Thanks to advanced techniques, you can probably look forward to good results.

Before Surgery
After you check in at the hospital or surgery center, you may have routine blood tests.   Your arm may be placed in a sling, wrap, or splint.  Your anesthesiologist or nurse anesthetist will most likely talk with you about the type of anesthetic you'll be given.

Remember to ask us how long you'll be away from home so you can plan ahead.  Don't eat or drink after midnight the night before surgery.   Your stomach needs to be empty when you're given the anesthetic. Don't take aspirin or other anti-inflammatories the week before surgery, unless the doctor says you can.   Arrange for a ride home form the hospital.  Bring any x-rays or other medical records or forms that you are asked to bring.  Keep a positive attitude.  You're on your way to feeling better.

Risks and complications
As with any surgery, complications may arise.  These include:

• Infection
• injury to nerves or blood vessels
• stiffness or ongoing pain in your shoulder

We will discuss any other risks with you.

Arthroscopic Surgery
An arthroscope gives your doctor a detailed look at your rotator cuff.  It also allows him to do the surgery without large incisions.  Tiny instruments are inserted through incisions smaller than a button hole.  This surgery can be used for such things as making more space for tendon movement or repairing minor tears.

Open Surgery
To repair complete tears in your rotator cuff, open surgery is usually needed.   The incision is larger than in arthroscopic surgery.  Healing and rehabilitation may take longer.

Helping it Heal
Your shoulder will heal faster if you follow the treatment and exercise program prescribed for you.  At first, you'll probably be using cold packs and a asking or a splint.  You may be told to gently move your shoulder to prevent stiffness and swelling.  To help move it, you may be asked to use a continuous passive motion (CPM) machine.

Our doctors will need to check your shoulder as your rotator cuff heals.  During the follow-up visits, the doctor will check your shoulder's mobility and function.   If needed, your treatment plan will be changed to improve your recovery. The number of visits you'll need depends on your injury and your treatment plan.

Call us if you notice any of these signs:

• Increased pain or swelling
• Drainage from the wound
• Numbness
• Redness
• Bleeding
• Fever

Staying Strong
Maybe your shoulder is healing without surgery.  Maybe you're recovering from surgery.  In either case, your shoulder's starting to feel good again, and you want to keep it that way.  From now on, think about how you're moving.  Try not to strain your rotator cuff.  And remember to exercise.  It's one of the best ways to keep your shoulder fit and strong.

Smart Moves
Ease yourself back into healthy everyday activities.  Remember the following:

• Don't push, pull, lift, or carry anything heavy while your shoulder heals.
• Avoid long periods of overhead shoulder activity (like reaching or throwing) while your shoulder heals.
• Use good posture.  Stand straight and relaxed without slouching.
• Don't read or watch TV propped up on the arm or elbow of your injured shoulder.
• Don't sleep on your injured shoulder
• Use your daily, even if it hurts a little.  A stiff, inactive shoulder takes longer to heal.

Finally, once your shoulder has healed and you've learned how to move safely, you can start living the way you used to.  Get back in the ball game.  Play with your puppy.  Work up a sweat.  Nothing feels better than feeling strong again.