Rotator Cuff Disease
Injuries to the shoulder due to repetitive overuse or a trauma often cause rotator cuff pathology. This can be diagnosed with a combination of clinical history, physical exam findings, and diagnostic imaging. Most often, the supraspinatus is the injured tendon of the four rotator cuff tendons. Sometimes the subscapularis, infraspinatus, or teres minor may be injured as well. The body will often try to protect the injured tissue from further injury by developing a bursitis of the sub-deltoid/sub-acromial bursa. There may be 'winging' the scapula in an effort to prevent further impingement of the rotator cuff. Most often, multi-modal rehabilitation exercises and time can improve these symptoms.
What happens if you are part of the minority that don't improve? One can consider ultrasound-guided platelet rich plasma for the treatment of tendon pain that has not improved with rehabilitation and time. In this procedure, a small amount of your own blood is taken and “spun” in a special machine that concentrates the pro-healing substances - the platelets and growth factors. This substrate (Platelet Rich Plasma) is then injected into the damaged tissue via ultrasound-guidance for safety and accuracy. Some patients may require up to 3 treatments at a 4-6 week intervals to improve their pain and dysfunction. After a week-long recovery post treatment, patients are encouraged to follow up with their preferred rehabilitation professional for 'rescue' treatment to help settle their symptoms. After the completion of the full treatment protocol, it is likely that strengthening the rotator cuff and scapular control (upper back muscles) will be required to achieve the best outcome.