Treating rotator cuff tear
By Lee Sung-hun
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With the winter almost upon us, cold weather is affecting everyone with muscle and joint flexibility as they tense up more than usual.
One of the most frequent complaints during this season is about shoulder pain.
Most middle-aged patients that suffer from such pain initially believe they suffer from adhesive capsulities (commonly known as “frozen shoulder”). However, the more likely cause is a rotator cuff tear.
The shoulder joint is surrounded by four muscles ― supraspinous, infraspinous, subscapular and teres minor muscles ― and together they are called the rotator cuff.
Each muscle supports the shoulder joint from the front, top and back to allow the rotation of the arm. Of the rotator cuff muscles, the tendons of the supraspinous muscles are most prone to damage, because they are located right below the acromion (a bony process on the shoulder blade), which covers the rotator cuff like a rooftop.
Structurally, the supraspinus tendons rub against the acromion whenever there is shoulder joint movement and friction caused from there can damage them subsequently.
Rotator cuff damage with younger people is generally related to excessive exercise, severe shock, trauma or hard labor. Repetitive arm-lifting movements from tennis, baseball or swimming are typical examples.
On the other hand, rotator cuff damage with the over-50s is generally caused by the degenerative changes that cause impingement with the shoulder bones. A full thickness rotator cuff tear can occur when there is an additional external trauma, such as when you fall from a high place.
In general, the most common cause for rotator cuff tears is degenerative changes rather than excessive movement or exercises that put stress on the tendons, given that some 40 percent of rotator cuff tear patients have never done physically imposing labor and over 70 percent of them have jobs without much physical demands, such as an office worker.
Though the word “tear” evokes a fallacy that it can only be treated by a surgical operation, most rotator cuff tears― except for the full thickness tear ― are only partial tears that can be treated with conservative treatments and physical therapy.
While the aforementioned frozen shoulders require stretching and forced joint movements as part of the treatment, rotator cuff tears can be worsened by the same exercises. Some patients often make a false self-diagnosis and do the exercises.
The external symptoms of the two disorders are similar, but their treatments should be differentiated and practiced accordingly.
Rotator cuff tears are generally accompanied by shoulder pain, stiffness and sometimes weakened muscle strength. The pain starts from the front of the shoulder and spreads to the elbow in severe cases. Lifting the arm overhead oftentimes worsens it and causes more pain at night.
While the frozen shoulders are caused by the degenerative changes in the soft tissues of the shoulder joint that limit shoulder movement, roator cuff tears are partial or full thickness damage to the muscles that surround the shoulder. Thus, the former is a problem in the joint, while the latter is an issue with the muscle tendons.
Possible self-diagnosis
The patients of both these disorders complain of difficulties in lifting their arms, but there are differences.
If you are able to lift the arm passively, meaning someone aids you, you can suspect issues related with the rotator cuff. On the other hand, if you have pain lifting the arm either actively or passively, you can suspect frozen shoulders. Another tell-tale sign for rotator cuff injuries is weakened muscles for lifting the arm.
In general, pain alone is not a good indicator because there may not be enough nerve endings in the tear region that allow the patient to feel the pain. Some patients complain of weakened muscles but cite no pain, while others simply feel the pain subsided after a while.
While the frozen shoulder is a self-limiting disorder that can be naturally healed within a year or two, the rotator cuff tears can be spread to the adjacent tendons and tissues. Thus, the latter requires a proper diagnosis and more proactive treatments.
Oriental medicine uses the combination of acupuncture, cupping, pharmacopuncture, prescription drugs and physical therapy for treating rotator cuff tears. The goals of the treatments are focused on eliminating the root of the pain and restoring muscle strength to recover the full function of the shoulder.
Acupuncture can be practiced directly on the meridian points of the shoulder, or on the hands and feet to relax the tense tendons and relieve the blood stasis to alleviate the pain. Cupping achieves similar effects by releasing the tension of the surrounding muscles and removing the blood stasis in the affected area.
Pharmacopuncture determines the exact location of the lesion to directly administer the effective substances. It alleviates the pain and promotes the regeneration of the tendons.
Prescription in Oriental medicine lessens the inflammation of the shoulder area and promotes the blood circulation to ease the pain and help damaged tissues to recover.
Such treatments ensure the range of motion in the shoulder joint fully recovers when physical therapies for strengthening muscles are employed.
Exercises that strengthen muscles should be practiced only after pain is managed sufficiently.
For patients with acute tear by an external trauma, severe functional disability or athletes having repetitive motions requiring overhead arm lifting, conservative treatments may be effective, but sometimes surgical options are required for treating the tear.
However, most rotator cuff tear patients can be healed with the aforementioned conservative treatments and recover their shoulder functions to have daily lives without any pain.
The writer practices Korean oriental medicine at the UN Oriental Medical Clinic in Hannam-dong, Seoul.