As little league seasons baseball and softball seasons across the country get ready to kick off, clinicians like us prepare to see an influx of shoulder pain cases and rotator cuff injuries. A common question we get this time of year is, "Is the rotator cuff torn?" and "Does it need surgery?" While a rotator cuff injury and tear can be extremely painful and debilitating at times, evidence shows us that surgery may NOT actually be the best option sometimes and that injury can heal on its own and with conservative care!
After the injury occurs, many people get an MRI or other type of imaging of the shoulder to see if the rotator cuff is torn. MRIs and imaging are expensive and can take weeks to get done sometimes, delaying the start of care. Recent studies have shown that a full-thickness rotator cuff tear can be detected "98%-100%" of the time with ultrasound and MRI respectively. But a partial-thickness tear (meaning the tear does not go through the entire muscle) is only detected "63%-68%" of the time. This means even though a small tear is present, the imaging may miss it anyways! The best option initially is to seek a skilled conservative care practitioner first; someone who can diagnose the tear as partial or full-thickness accurately and can make the appropriate recommendation for imaging or to start treatment quickly. The External Rotation Lag Sign (ERLS) is an extremely accurate test to detect a full-thickness rotator cuff tear. If the test is negative, the probability that the tear is NOT full-thickness is very high and rehab of the shoulder can begin as soon as possible.
Watch a video of the External Rotation Lag Sign here!
If the tear is partial-thickness, conservative care and rehabilitation have been shown to accelerate the healing process, as partial-thickness tears have a much higher ability to heal and respond to strengthening exercises. A study shows us that "26.1% of symptomatic partial-thickness tears increased in size," meaning while the injury may heal on its own, the potential for further injury is low but still present. Quicker diagnosis and quicker treatment will lead to less degeneration in the tissue, faster return to play, and a drastically decreased chance for reinjury in the future.
If the tear is full-thickness, evidence shows us that surgery actually is a very good option. A recent study shows that "82.4% of symptomatic full-thickness rotator cuff tears increased in size over a follow-up period of months" meaning the chance of the injury getting worse is very high in a full-thickness tear. An MRI to confirm the tear is usually very accurate as we said before, which means surgery can be scheduled quickly and the rehabilitation process can begin.
The short version... if your athlete is having shoulder pain and you think it may be a rotator cuff injury, seek care immediately! While mild injuries can heal, the degeneration can begin leading a snowballing cycle of injury, resting for sport, improper healing, return to sport, reinjury, and longer time out of the sport, and potentially more serious injury. Quick diagnosis and proper treatment based on the type of injury is the key to proper healing and getting your athlete back on the field as quickly and safely as possible.