Rotator cuff is the name commonly used to indicate the shoulder muscle complex, the most mobile joint in the human body.
This joint is as complex as it is delicate, and is included in the list of the joints most prone to injury and degradation.
The pain triggered by various pathologies is generically defined as "periarthritis"; however, each clinical picture should require specific and appropriate therapy.
Of all the discomforts, the most frequent is undoubtedly tendinopathy (tendinitis, calcifications, rupture, etc.); followed by acute injuries, arthrosis and painful irradiation that start from the neck.
The rotator cuff is composed of 5 joints, 26 muscles and at least twice as many tendons. It is a very complex structure and the lesion could be located in any of the many locations.
Statistically, the areas of most interest are the tendons of the supraspinatus and sub-spinal muscles.
What to do
- Prevention: essential especially when the subject is aware of a family predisposition, has an associated medical history or recognizes other factors related to the increase in risk (environmental elements).
- Symptom recognition: in order to speed up the diagnostic time it is necessary for the subject to be aware of which "could" be the related symptoms; for example:
- Suffering during:
- Execution of specific movements.
- Palpation in specific districts.
- Joint stiffness, first morning associated with pain and then constant.
- Sensation of instability, especially during specific gestures and in more intense cases even at rest.
NB . Functionality is generally impaired due to muscle weakness and thinning, elongation and tendon tenderness.
- In the presence of suggestive symptoms, undergo a general and subsequently orthopedic medical examination with:
- History: functional evaluation (rotator cuff test), palpation, etc.
- Diagnostic examinations with images (also to exclude other pathologies or comorbidities):
- Ultrasound.
- Radiography.
- Magnetic Resonance.
- Lifestyle change: partly equal to certain preventive measures, it includes above all:
- Correction of movements that involve activation of the shoulder and specific tendon muscles.
- Adjustment of overloads.
- If necessary, correction of the sport-motor technique (for example the back stroke in swimming).
- Choice of the most suitable instruments and aids and / or use of automated methods in certain working phases.
- Application of conservative therapy and / or surgery:
- Conservative therapy:
- Discharge of the rotator cuff from potentially harmful stimuli.
- Preventive gymnastics for strengthening hypotrophic and stretching muscles.
- Cryotherapy or cold therapy: useful in the acute phase, it works by reducing inflammation and calming pain.
- If there is a chronic or mild tendon injury, some specialists suggest heat therapy to improve vascularization and facilitate healing (to be avoided in the event of acute injury with vessel rupture).
- Anti-inflammatory drugs (non-steroidal or corticosteroids).
- Medical treatments: useful for reducing inflammation and pain as well as stimulating tissue repair.
- Surgery: used when the tendons calcify or break, or when other complications are present (bone spurs, ligament damage, etc.).
- Preparation for surgery and post-surgical rehabilitation: physiotherapy and strengthening.
- The most used reinforcement exercises (to be performed with rubber bands) act on the supraspinatus and on the infraspinatus; they are: lateral risers (controlled movement) combined with external rotation exercises of the scapula, pulley, vertical row with high grip and T bar.
What NOT to do
- Make use of anabolic steroids by greatly increasing strength compared to tendon resistance.
- Neglecting prevention.
- Ignore the symptoms that could potentially guarantee an early diagnosis.
- Self-care: this does not allow a certain diagnosis and increases the risk of the disease getting worse.
- Do not go into medical history by conducting imaging surveys.
- Preserve work habits, hobbies, sports activities and, more generally, incorrect or painful ones.
- Perform strengthening exercises harmful to the districts involved:
- For lesions of the supraspinatus muscle and attached structures one must avoid: shoulder press, slow with balance and slow with dumbbells (front and back), rear lat machine, heavy and heavy lateral lifts, pulled to the chin.
- For the injuries of the infraspinatus muscle and related structures one must avoid: chest press, dumbbell press, flat and inclined bench presses.
- Follow therapy incorrectly or discontinuously (medications, physiotherapy, medical treatments, etc.).
- Exclude surgery when needed.
What to eat
There is no diet suitable for the prevention or treatment of rotator cuff injuries. However, nutritional status can positively or negatively affect inflammation.
- It could be useful to increase the intake of nutrients with a strong anti-inflammatory function:
- Omega 3: are eicosapentaenoic acid (EPA), docosahexaenoic (DHA) and alpha linolenic acid (ALA). They play an anti-inflammatory role. The first two are biologically very active and are found mainly in: Sardinian, mackerel, bonito, alaccia, herring, alletterato, ventresca of tuna, needlefish, algae, krill etc. The third is less active, but constitutes a precursor of EPA; it is mainly contained in the fat fraction of certain foods of vegetable origin and in the oils of: soy, linseed, kiwi seeds, grape seeds, etc.
- Antioxidants:
- Vitaminics: the antioxidant vitamins are carotenoids (provitamin A), vitamin C and vitamin E. Carotenoids are contained in vegetables and red or orange fruits (apricots, peppers, melons, peaches, carrots, squash, tomatoes, etc.); they are also present in shellfish and milk. Vitamin C is typical of sour fruit and some vegetables (lemons, oranges, mandarins, grapefruit, kiwi, peppers, parsley, chicory, lettuce, tomatoes, cabbage, etc.). Vitamin E is available in the lipid portion of many seeds and related oils (wheat germ, maize germ, sesame, kiwi, grape seeds, etc.).
- Minerals: zinc and selenium. The first is mainly contained in: liver, meat, milk and derivatives, some bivalve molluscs (especially oysters). The second is contained above all in: meat, fishery products, egg yolk, milk and dairy products, fortified foods (potatoes, etc.).
- Polyphenols: simple phenols, flavonoids, tannins. They are very rich: vegetables (onion, garlic, citrus fruits, cherries, etc.), fruit and related seeds (pomegranate, grapes, berries, etc.), wine, oilseeds, coffee, tea, cocoa, legumes and whole grains, etc.
What NOT to Eat
- Eliminate alcohol: compromise drug metabolism.
Natural Cures and Remedies
- Static or dynamic stretching: muscles that are not very elastic (particularly if they are hypertrophic) are more prone to injury and tend to stress the tendons excessively during stretching. This is why stretching is considered both preventive and rehabilitative.
- Motor exercises for reinforcement: used in conservative therapy, in preparation for surgery and in subsequent rehabilitation. They are particularly useful in shoulder tendonitis where the trigger is a reduction in muscle tone that causes tendon distension.
WARNING! It is inadvisable to over-stretch and reinforce gymnastics; in addition to generating pain, they could favor the breaking of a particularly thinned tendon.
- Cryotherapy: cold therapy is useful in reducing pain and inflammation. It should be performed 2 or 3 times a day. Ice should not be applied directly; on the contrary, it must be placed in a bag containing water and applied by interposing a woolen cloth to protect the skin.
- Heat therapy: increases blood flow and can speed recovery of a tendon injury. It must not be used in the presence of vascular lesions.
- Guardians: of various kinds, they can be useful to limit the movements of the rotator cuff or to support it after surgery.
Pharmacological care
Inflammation can cause severe tendinopathies that unduly weaken the tendons and generate calcifications.
Pharmacological treatments for rotator cuff pain are mainly anti-inflammatory.
- Non-steroidal anti-inflammatory drugs (NSAIDs):
- Systemic for oral use: they are more used than topical ones, as the structures of the rotator cuff are difficult to reach through skin application. They are also more powerful than ointments and gels. They may require the use of a gastroprotector. Those who suffer from liver or kidney disorders are not always able to take them.
- Ibuprofen: eg Brufen ®, Moment ®, Spidifen ®, Nurofen ®, Arfen ®, Actigrip fever and pain ® and Vicks fever and pain ®).
- Ketoprofen: for example Artrosilene ®, Orudis ®, Oki ®, Fastum gel ®, Flexen "Retard" ® and Ketodol ®.
- Diclofenac: for example Dicloreum ®, Deflamat ®, Voltaren Emulgel ® and Flector ®.
- Naproxen: for example Momendol ®, Synflex ® and Xenar ®.
- For topical use: they are mainly ointments or gels. They have the advantage of acting locally and without overworking the stomach and liver; however they are not very effective. It is NOT the most suitable pharmacological category and to insist with their use for a long time could favor the worsening of inflammation.
- Ibuprofen lysine salt 10% or Ketoprofen 2.5% (eg Dolorfast ®, Lasonil ®, Fastum gel ® etc).
- Corticosteroids:
- Injectable or oral: they are used only if the oral NSAIDs are not well tolerated for: allergy, gastric ulcer, diabetes etc. Using those injectable for long periods can cause many side effects on connective tissues, particularly on tendons. On the other hand, they represent the most drastic and effective pharmacological solution.
Prevention
The prevention of pain localized in the shoulder mainly affects the discomforts related to tendon inflammation.
- In this case, the first rule is undoubtedly that of putting a lot of attention to the movements to be performed:
- Accurate warming is essential before sports gestures.
- Control the movements in maximum articular excursion ..
- Don't overload your shoulder in unnatural postures.
- For athletes it is essential to take care of physical preparations also in terms of elasticity and mobility (stretching, etc.).
- In case of postural defects it is necessary to correct them; for example, dorsal hyperciphosis may be the cause or aggravation of rotator cuff inflammation.
- In the presence of a painful symptom or due to joint instability, contact your doctor.
- If the diagnosis is positive, take action to:
- Optimize muscular trophism.
- Gain stability of the articular cuff.
- Improve tendon integrity.
- Eventually remove the tendon calcifications or bone spurs surgically or with medical treatments.
- Avoid creating imbalances between tendon resistance and muscle strength (as is the case with the use of anabolic steroids in sports).
- Review tools and manual aids in work, hobbies and sports, both in ergonomic and weight terms.
Medical Treatments
- Tecar therapy: it is a therapeutic method that uses an electric condenser to treat muscle joint injuries and tendinopathies. The mechanism of tecarterapia is based on the restoration of the electric charge in the injured cells, to make them regenerate more quickly.
- Laser therapy: it is a treatment that uses electromagnetic rays directly on the affected area. The laser electron beam acts on the cell membrane and mitochondria, increasing metabolic activity, reducing pain and inflammation, creating vasodilation and increasing lymphatic drainage.
- Ultrasound: this system uses high frequency acoustic waves. It is very useful as an anti-inflammatory, stimulating edematous reabsorption and to dissolve the adhesions that are formed during healing. It produces heat and increases the permeability of cell membranes.
- Shock waves (Extracorporeal Shock Wave Terapy): crumble modest tendon calcifications. They are based on the localized release of acoustic impulses.
- Kinesio taping: it is not very effective for the rotator cuff. It can be used in milder forms. It uses the traction of adhesive and elastic bandages, which sometimes contain small pharmacological concentrations of anti-inflammatories, applied to the skin. They should have a draining, slightly pain-relieving-anti-inflammatory and guardian function.
- Surgery: it is essential for the repair of a total rupture of injured tendons and sometimes for the removal of calcifications.
- Physiotherapy, strength training: useful in conservative therapy and both before and after surgery. They improve muscle strength, prevent / cure stiffness and optimize functional recovery.
