Chronic Shoulder Instability, Dead Arm Syndrome, Rotator CUFF
Ross Hauser, M.D.
 

A natural consequence of weakened or injured shoulder ligaments is chronic shoulder instability. This situation may occur as a result of previous Shoulder Dislocations, but may also occur due to congenitally loose joints or from repetitive motion injury as in pitching. Repetitive microtrauma, occurring as a direct result of these injuries, begins to take its toll on the supporting structures of the shoulder and disrupts the delicate balance between mobility and stability. Subtle signs of joint instability and laxity become evident, including pain with abduction and external rotation (called a Positive Apprehension Test), tenderness to palpation throughout the shoulder joint, and the subjective feeling of weakness in the arm (Dead Arm Syndrome).
 

Rotator Cuff Tendonitis
A secondary problem to chronic shoulder instability is rotator cuff tendonitis (RCT). Rotator cuff tendonitis may occur when the muscles of the rotator cuff, which include the supraspinatus, infraspinatus, teres minor, and subscapularis, are overworked causing the tendon to become inflamed and painful. The more common scenario of RCT occurs when a chronically unstable shoulder forces the muscles of the shoulder, especially the rotator cuff muscles and tendon, to work beyond their capabilities to stabilize the shoulder as it moves through its complex pitching motions. These small rotator cuff muscles were not designed to stabilize the shoulder or perform the major work in shoulder motion, but instead should function to perform shoulder rotation. Chronic ligamentous instability can lead to rotator cuff tendonitis, but the treatment of Prolotherapy can treat both the instability and the secondary tendonitis that follows.

The important point for the pitcher to remember is that pain is your body telling you that something is wrong. The time to get treatment is not when your shoulder finally goes out, but when the pain first starts. Shoulder problems either manifest as shoulder pain or weakness. A pitcher feeling weak requires shoulder examination. Pain and/or weakness are common signs of ligament weakness. Ligament weakness in the shoulder will almost always lead to a rotator cuff tendonitis. If this is not treated, the rotator cuff muscles will give out, putting even more stress and strain on the ligaments. Eventually shoulder instability develops. This can only have one of two end results: arthritis or shoulder dislocation. The best approach is to stop the whole shoulder ligament-injury-arthritis process by treating with Prolotherapy. Prolotherapy treats the root cause of shoulder instability and rotator cuff tendonitis not only by strengthening the rotator cuff tendons, but also correcting the shoulder ligament weakness.

Rotator Cuff Tendonitis and Impingement Syndrome

Rotator cuff tendonitis occurs when the small muscles of the rotator cuff, the supraspinatus, infraspinatus, teres minor, and subscapularis, become strained causing weakness of these structures and subsequent tendonitis. Once the balance between motion and joint stability is altered through weakness in the static structures (ligaments) or the dynamic structures (rotator cuff muscles), pain and impaired function will invariably ensue. Pitchers are prone to rotator cuff tendonitis and impingement syndrome because of the overhead movement involved in throwing a baseball and because the rotator cuff, in this psoition, is at its most vulnerable.

Common treatment for rotator cuff tendonitis and impingement syndrome by traditional medical doctors includes rest, NSAIDS (nonsteroidal anti-inflammatory drugs), physical therapy, and cortisone injections. Because a cortisone injection has very strong anti-inflammatory properties, it may reduce the swelling in the tendon and bursa, relieving the symptoms. These treatments may temporarily help, but since the underlying cause has not been addressed the problem invariably returns. Degenerative fraying and tearing of the tendon may occur if constant irritation of the tendon occurs from the impingement process over time. The best way to treat this unresolved process is with Prolotherapy injections to the ligaments and tendinous insertions of the rotator cuff and deltoid. This, combined with gradual re-strengthening of the rotator cuff muscles, give an excellent chance for a full recovery and performance.

If the rotator cuff tear has become large enough to produce profound weakness in the shoulder, shoulder surgery may be necessary and Prolotherapy can be used as a post-operative treatment to improve tissue strength and overall recovery.