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A Physical Therapist’s Analysis of Zach Davies’s Shoulder Injury

As of recently, Brewers pitcher Zach Davies was placed on the 10-day disabled list due to rotator cuff inflammation. Because of this, a few of you may be wondering how serious a rotator cuff injury is, how soon Zach Davies will return, and what the Brewers are doing to get him back on the field as quick as he can. Keep reading to see what one of our physical therapist’s, David Tranchita, has to say.

 

What is rotator cuff tendinitis?

Rotator cuff tendonitis, also known as impingement syndrome, is when your shoulder tendons become inflamed or irritated due to a repetitive or overuse activity. In Zach Davies’s case, throwing a baseball hundreds of times during a short period of time could’ve caused his rotator cuff tendinitis.

This condition usually occurs over time. It can be the result of keeping your shoulder in one position, sleeping on your shoulder, or participating in activities that require overhead arm movements.

Because athletes who participate in sports that require a lot of overhead arm movements commonly develop rotator cuff tendinitis, this injury is sometimes referred to as:

  • Swimmer’s shoulder
  • Pitcher’s shoulder
  • Tennis shoulder

Sometimes rotator cuff tendinitis occurs without any known cause. However, most people with rotator cuff tendinitis are able to regain full function of their shoulder without any pain, when they receive the proper treatment.

 

What are the symptoms of rotator cuff tendinitis?

Rotator cuff tendinitis symptoms tend to get worse over time. Initial symptoms may be relieved with rest and ice, but the symptoms can later become constant. Symptoms that go past the elbow usually indicate another problem, like a pinch nerve in the neck region.

 

Symptoms of rotator cuff tendinitis:

  • Pain and swelling in the front of the shoulder and side of your arm
  • Pain triggered by raising or lowering your arm
  • A clicking sound when raising your arm
  • Stiffness
  • Pain that causes you to wake up in the middle of the night due to sleeping on that side
  • Pain when reaching behind your back
  • Loss of mobility and strength in your arm

 

How is rotator cuff tendinitis diagnosed?

If you’re having symptoms of rotator cuff tendinitis, your doctor will begin by examining your shoulder. You’ll be checked to see where you’re feeling pain and tenderness. Your doctor will also test your range of motion and strength and do special (provocation) tests to see if your symptoms are reproduced by certain movements.

Your doctor may also examine your neck for conditions such as a pinched nerve or arthritis that provide similar rotator cuff tendinitis symptoms.

Your doctor may also order imaging tests to confirm the diagnosis of rotator cuff tendinitis and rule out any other causes of your symptoms. Additionally, an x-ray may be ordered to see if you have a bone spur. Lastly, your doctor may order an ultrasound or MRI scan to check for inflammation in your rotator cuff and to see if there are any signs of tearing.

 

How is rotator cuff tendinitis treated?

Initial treatment of rotator cuff tendinitis involves managing the pain and swelling, which will promote healing.

 

How to manage rotator cuff tendinitis pain and swelling:

  • Avoid activities that cause pain
  • Apply cold packs to your shoulder three to four times per day
  • Take nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) and naproxen (Aleve)

 

When the above treatment options are not effective, many people seek additional treatment options such as:

Physical therapy:

Your doctor may refer you to a physical therapist. Physical therapy will initially consist of stretching and other passive exercises to help restore range of motion and ease your shoulder pain.

Once the pain is under control, your physical therapist will teach you exercises to help you regain your arm and shoulder strength.

 

Steroid injections:

If your rotator cuff tendinitis is not being managed by more conservative treatment, your doctor may recommend a steroid (cortisone) injection. The cortisone shot is injected into the tendon to reduce inflammation, which reduces pain. Physical therapy is then commonly recommended to help you strengthen your muscles and get you back to the activities that you love to do.

 

Surgery:

If nonsurgical treatment is not successful, your doctor may recommend surgery. Most people have a full recovery after rotator cuff surgery.

The most noninvasive form of shoulder surgery is accomplished via arthroscopy. This surgery involves two or three small cuts around your shoulder that your doctor will then insert various instruments into. One of these instruments will have a camera, so that your surgeon can view the damaged tissue.

Open shoulder surgery is usually not required for rotator cuff tendinitis. However, this method may be used if you doctor discovers other problems in your shoulder like a large tendon tear.

Plenty of rest and physical therapy are typically recommended after surgery to restore your strength and range of motion.

 

Home care for your shoulder:

You can do several things at home to help reduce rotator cuff tendinitis pain. These techniques can also help prevent rotator cuff tendinitis or another flare-up of pain.

  • Practice good posture while sitting
  • Avoid lifting your arms repetitively over your head
  • Take breaks from repetitive activities
  • Avoid sleeping on the same side every night
  • Avoid carrying a bag on only one shoulder
  • Carry things close to your body
  • Stretch your shoulders throughout the day

 

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