With the nicer weather, many people are getting back to their summer activities. If that includes throwing, it may result in shoulder pain.  Many people who are familiar with rotator cuff problems and throwing sports may have a tendency to make people all too aware of their “cuff”. Not only does this usually result in pain with overhead activities, but it also is noticeable with throwing. They may notice that the intermittent discomfort they have felt in the past is longer lasting or more severe and may bother them at night.

It is helpful to understand the function of the rotator cuff. The cuff consists of 4 muscles that surround the ball of the shoulder joint. When they function normally, they help the ball stay centered in the socket so the larger muscles can provide the strength needed for activities. As the tendon looses effectiveness, for multiple reasons, the ball tends to move a bit abnormally and may cause the tendons to rub or impinge on the bone above the shoulder joint. Strength and function will be fairly normal at lower body levels but it becomes significantly more weak and painful as the arm is raised above chest level, especially with weight in the hand.

Treatment usually begins with trying to reduce the inflammation around the shoulder with ice, possible medications or an injection. One should limit the activities that cause the pain and with instruction try to work at building up better function of the muscles of the cuff. Your physician may discuss the use of an MRI to further evaluate the shoulder and specifically to try to identify a tear in the tendon. The tendon has a very poor healing rate and if there is a significant tear it may be treated surgically.

Rotator cuff repairs can typically be done through the scope which may offer some advantages but the recovery process still takes a long time. There are many factors that play a part in the recovery but one could expect 3-4 weeks with a sling. Physical therapy is used to help get motion back and gradually into strengthening. This will easily take 3-4 months and some may still see improvement out to 1-11/2 years. For those interested in throwing, they have a longer course with throwing programs starting about 4-6 months after surgery and can last another 4-9 months. Returning to throwing is the greatest challenge.

Dr. Paul Reyen
Sanford Clinic Orthopedics & Sports Medicine