Rotator Cuff Tear or Tendonitis

The rotator cuff tendons, especially Supraspinatus, is one of those spots in the body that is set up to fail. Why you ask? Well the tendon is located in a "watershed" area between two bones, the head of the Humerus below and the Acromion above with not great blood supply. Every time the arm is elevated, the blood supply is further impacted by the Humerus pinching against the Acromian. In people who have a "down sloping" Acromion, the pressure arrives on the tendon earlier than usual, and over time the tendon weakens in the area with poor blood supply, and the tendon can tear when loaded. I have seen so many people with surprising stories about how they ended up tearing the Supraspinatis tendon, from being pulled behind a boat while water skiing on one hand to playing basketball and catching an arm while shooting on the other.

A tear in the RC Cuff can be full thickness or partial thickness. A partial thickness tear can produce some shoulder pain, usually out on the lateral side of the shoulder, and it can "hide" being mostly pain free, or produce an achy shoulder from time to time. I had a partial thickness tear in my left shoulder from an gymnastics injury in high school when I was 17 years old, and it came and went for years until I tore it again playing basketball when I was 38 years old. At that point the tear was deep enough to bother me all the time, and especially at night. Night time shoulder pain is one of those "red flags" that implies that further testing is appropriate. If you are having hard time lifting things, opening your car door, and coping with unexpected movements, its time to see you doctor!

The good news is that an accromioplasty (shaving the underside of the acromion) and a rotator cuff repair (shaving off the torn part) is a quick recovery, but the full thickness tear is more work. Here is a good full thickness surgery repair blog

Even after the full thickness repair, a full recovery is completely possible...you can read more about recovering from injuries on my website here.

That Crazy Pain in My Shoulder!!

Today, a 45 year old baseball pitcher described a pain in his shoulder that only hurt when he crossed his arms and pressed his fist into the back of his arm, pushing his arm forward causing local pain in the front of the shoulder more or less. He also described getting grossly fatigued while pitching, losing both velocity and staying power. The pain came on originally after he pitched through an illness.

Physical exam was insignificant. Rotator cuff screens were negative as was the AC joint screen. Palpation unable to reproduce symptoms. Muscle test negative. Neuro negative. Joint play negative. The only positive symptom occurred with him reproducing the anterior glide of the humeral head on the glenoid using his other hand behind the involved right arm.

My conclusion is that he tore his Glenoid Labrum. We will find out for sure after he has an MRI or surgery if the surgeon decides to go that way.




The Labrum seats around the Gelnoid Fossa to make it effectively deeper for the Humerous to seat properly. When the Labrum tears, it can tear on the top (a SLAP lesion) or on the bottom (a Bankart lesion). You can see the proximity of the biceps lesion to the superior tear in the Labrum, and for this reason, many SLAP lesions actually also involve the Biceps Tendon.



In the event that you actually have a torn Glenoid Labrum in either form, the SLAP lesion or the Bankart tear, I am afraid that the best option is surgical. The good news is that recovery is excellent. The last patient I treated who had surgery for this condition, had both the SLAP and the Bankart lesion, and he went on to a full recovery after surgery by playing college football just a few months later.

Rehab for the post surgical course is not very complex, it just takes hard work. Starting with immobilization, then self mobilization activities, to full ARROM to strengthening to dynamic strengthening and throwing ultimately.

Its a long road back for sure, but the route back to full participation is certain. "Bulletproof" shoulders are possible after surgical repair.

The Mysterious Biceps Tendonitis

I am often confronted by "hard to diagnose and persistent shoulder pain" that is incorrectly labeled "rotator cuff syndrome". The long head of the biceps is susceptible to the aforementioned "hard to diagnose, difficult to treat" tendinitis that once correctly identified can in fact be quite easily treated.

The key is to accurately locate the source of the pain as the biceps tendon long head in the bicipital groove, and then to make it geographically available so that treatment is accurately delivered. In the diagram below, you can see the tendon groove and the long head tendon that lives there.



In normal standing posture, the biceps groove lives toward the inside of the humerus closer to your body so that when your arm is against your body and your hand in front of you or at your side naturally, the biceps groove is "hidden". In this case, palpation of the groove is impossible, and direct treatment is ineffective.

In order to palpate the biceps groove, externally rotate your arm, and you will feel a little bump under your fingers as the edge of the groove goes by. If your shoulder hurts under your fingers as the groove goes by, you can safely assume that your biceps tendon is involved.

In order to effectively treat the long head of the biceps tendon, you need to expose the biceps groove by externally rotating the arm so that the biceps groove faces forward. Once positioned as described, you should perform ice massage for about 5 or 10 minutes over the biceps groove and humeral head, and in most cases that will make all the difference.