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Rotator Cuff Tear

Are you plagued by shoulder pain that has now transitioned from intermittent to constant and keeps you up at night? Are daily shoulder movements, such as dressing and reaching for objects in the kitchen cabinets, painful? Is your range of motion decreasing as your pain is increasing? You may have a full- or partial-thickness rotator cuff tear.

Has conservative therapy in the form of heat, ice, stretching, rest, and acupuncture failed to provide significant relief?

Has an MRI demonstrated a full-thickness or partial-thickness tear of the rotator cuff? What to do?

What Is the Rotator Cuff?

The rotator cuff (shown above) is a group of four muscles and tendons that act to stabilize the shoulder. These muscles include the following:

  • Supraspinatus
  • Infraspinatus
  • Subscapularis
  • Teres Minor

What Causes Rotator Cuff Tears? (Aging, Trauma & Overuse)

Aging

As we grow older there is a tendency for the rotator cuff tendons to become more fragile and susceptible to injury.  Just as your skin wrinkles and your hair turns gray, the likelihood of having a tear increases as you grow older.  Why does this occur?   As we age the number of stem cells in the tendon declines (4).   The lower the stem cell count the more susceptible the tendon is to injury including tears.

Trauma

Sports, motor vehicle accidents, and other forms of trauma can cause rotator cuff tears.

Overuse

Weight lifters and other athletes and workers who used their shoulders extensively are at risk for tears.

Symptoms of Rotator Cuff Tear

The following are some of the symptoms and effects associated with a rotator cuff strain:

  • A dull aching deep in the shoulder
  • Sleep disruption
  • Limited range of motion (making it a challenge to put on clothes or brush your hair
  • Arm weakness should be avoided by being accompanied by someone.

Arm Pain at Night

Arm pain at night can be miserable.  The pain can interrupt your sleep and erode your quality of life. Irritability becomes increasingly more common.  What are the causes?  When should I worry about it?  What are the treatment options for arm pain at night? The neck is composed of 7 boney building blocks numbered 1- 7. Sandwiched between the bones is a disc that functions as an important shock absorber. The cervical discs are susceptible to injury due to trauma, degeneration, repetitive motion, and surgery. Common disc injuries include disc bulges, and herniations. The injured disc can compress or irritate one or more nerves resulting in arm pain at night. It can…

Read More About Arm Pain at Night

Left Shoulder Blade Pain

Learn to know the symptoms and causes of shoulder blade pain as well as the diagnostic tests to run for it and its treatment options. Shoulder blade pain can be a common, annoying, hard to diagnose problem. There are many different causes of shoulder blade pain and the exact cause of the shoulder blade pain will determine what type of treatments would be recommended.

Read More About Left Shoulder Blade Pain

Shoulder Pain at Night

There are several reasons why shoulder pain at night occurs or is aggravated; The common explanations include: Sleep typically involves a static position lasting hours at a time with little or no movement. Sleeping on your side places additional pressure on the tendons and bursa of the shoulder. Sleep can cause muscles and tendons to settle in a slightly different position resulting in additional pressure and reduced blood flow. Identifying the underlying problem is important!  This allows therapy to focus exclusively on the exact problem or problems.  When appropriate conservative care is always the first line of treatment.  Focus is typically on strengthening and improving range of motion. 

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Shoulder Pain When Reaching Across Body

Shoulder pain can make simple chores almost impossible.  Have you ever reached for an object high on a shelf only to have pain that takes your breath away?  What causes shoulder pain when reaching across the body?  What is shoulder impingement?  What does shoulder impingement feel like?  Can a shoulder X-ray show shoulder impingement?  What are the treatment options for shoulder pain when reaching across the body? ulder impingement and rotator cuff injuries are among the most common causes of shoulder pain (1).  Both can cause shoulder pain when reaching across the body. Shoulder impingement is a painful condition in which the bursa and muscles of the shoulder are pinched or compressed. 

Read More About Shoulder Pain When Reaching Across Body

Why Does My Shoulder Hurt When I Lift My Arm?

Shoulder pain can be very non-specific, meaning that multiple structures and issues can cause identical pain in the shoulder. Most shoulder examination maneuvers are very limited in their ability to assess exactly what the problem is.  With pain when lifting your shoulder, it is critical to take a detailed history, good examination, coupled with imaging to fully understand what is causing the shoulder pain.  Many conditions can present with these symptoms

Read More About Why Does My Shoulder Hurt When I Lift My Arm?

What Is a Partial-Thickness vs a Full-Thickness Rotator Cuff Tear?

One or more of the four rotator cuff tendons or muscles may tear. Tears are classified and include a partial-thickness tear where only a portion of the tendon is torn, which is illustrated in the ultrasound image above, or a full-thickness tear where the tear extends across all five layers of the tendon.

What Is the Natural Course of a Symptomatic Full-Thickness or Partial-Thickness Rotator Cuff Tear?

Kim et al evaluated 122 patients with partial- and full-thickness supraspinatus tears that received nonsurgical treatment for rotator cuff tears. Tears were diagnosed by MRI. Mean follow-up was 24.4 months.  There were 27.9% of patients with full-thickness tears versus 72.1% with partial-thickness tears. Tear size increased 82.4% in patients with full-thickness tears and 26.1% with partial-thickness tears. The authors concluded that having a full-thickness tear was the most reliable risk factor of tear progression.

What to Do?

If left untreated, full-thickness and 26% of partial-thickness tears will progress. Patients run the risk that a rotator cuff tear can progress with the two edges of the tendon physically separating, which is termed retractions. Surgery is the only treatment option when this occurs. Beware, however, as rotator cuff tear surgery is associated with a high incidence of retears, which can exceed 75%.

Steroid Injection?

Steroids have been demonstrated to be highly toxic to tendons, cartilage, and muscle and should be avoided.

Platelet and Bone Marrow Concentrate Injections

At the Centeno-Schultz Clinic, we have over a decade of clinical experience treating rotator cuff tears with ultrasound-guided bone marrow concentrate injections (containing stem cells). The preliminary results of our ongoing randomized control study are reviewed below:

If you or a loved one suffers from ongoing shoulder pain from a rotator cuff tear that has not improved with conservative care, there is a good chance that it may progress. Rather than risk progression and possible retraction of the tendon, please schedule an evaluation at the Centeno-Schultz Clinic where you will be evaluated by a board-certified, fellowship-trained physician who will review your MRI, perform diagnostic ultrasound, and outline treatment options. Anything less may compromise your ability to get back into the game.

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Doctors Who Assist with Rotator Cuff Tears

Christopher J. Centeno, MD

Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…

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John Schultz, MD

My passion and specialization are in the evaluation and treatment of cervical disc, facet, ligament and nerve pain, including the non-surgical treatment of Craniocervical instability (CCI). I quit a successful career in anesthesia and traditional pain management to pursue and advance the use of PRP and bone marrow concentrate for common orthopedic conditions. I have been a patient with severe pain and know firsthand the limitations of traditional orthopedic surgery. I am a co-founder of the Centeno-Schultz Clinic which was established in 2005. Being active is a central part of my life as I enjoy time skiing, biking, hiking, sailing with my family and 9 grandchildren.

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John Pitts, M.D.

Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.

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Jason Markle, D.O.

Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.

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Matthew William Hyzy, D.O.

Doctor Hyzy is Board Certified in Physical Medicine and Rehabilitation (Physiatry) and fellowship-trained in Interventional Orthopedics and Spine. Dr. Hyzy is also clinical faculty at the University of Colorado School of Medicine in the Department of Physical Medicine and Rehabilitation; In addition, Dr. Hyzy is an Adjunct Clinical Assistant Professor at The Rocky Vista University College of Osteopathic Medicine. Dr. Hyzy also maintains an active hospital-based practice at Swedish Medical Center and Sky Ridge Medical Center. He is also recognized and qualified as an expert physician witness for medical-legal cases and Life Care Planning. He is published in the use of autologous solutions including…

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Brandon T. Money, D.O., M.S.

Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…

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Mairin Jerome, MD

Mairin Jerome, MD

Dr. Mairin Jerome is a physiatrist with subspecialty fellowship training in Interventional Orthopedics and Regenerative Medicine. This subspecialty serves to fill the gap for patients who are interested in therapeutic options that lie between conservative treatment and surgery. Dr. Jerome uses regenerative medicine techniques, including prolotherapy and orthobiologics, via X-ray or ultrasound guidance to precisely deliver injections to areas of musculoskeletal injury or degeneration. Orthobiologics refers to tissue harvested typically from a person’s own body, such as platelets (platelet-rich plasma, PRP) or bone marrow, for use in treating painful musculoskeletal conditions. The goal is to stimulate the body’s healing mechanisms to improve pain, function, and decrease inflammation.

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Other Resources for Rotator Cuff Injuries

  • New Interventional Orthopedics Atlas

    Writing a textbook is an enormous undertaking.  In creating a first of its kind, comprehensive textbook in Interventional Orthopedic Procedures, authors Williams, Sussman and Pitts have established a new benchmark in the field.  Congratulations to its authors for their dedication, foresight and commitment to the advancement of Interventional Orthopedics.  What Is Interventional Orthopedics?  Interventional Orthopedics … Continued


  • ACL Tear Treatment Without Surgery: Our New Publication!

    It all happened so suddenly.  You were running down the field and made a quick cut.  You heard an audible pop followed by searing knee pain and then collapsed to the ground. Your doctor thinks your tore your ACL and has referred you to a surgeon.  What is the Anterior Cruciate Ligament?  What is the … Continued


  • Ligaments of the Spine: Understanding Their Importance

    It started as a dull ache and now has progressed.  It feels like a knife in the back of your neck and is preventing you from daily activities.  Medications, rest and conservative treatments have failed.  Your doctor noticed on x-ray that the bones are out of alignment.  He thinks you may have suffered a ligament … Continued


  • Anterior Longitudinal Ligament: Could This Be Responsible for Your Ongoing Neck Pain?

    The neck pain is unrelenting, and all started after being rear ended at a stoplight. Spine X-rays demonstrated some abnormal movement of the Spinal bones.  Both conservative care and medications have failed.  Your doctor thinks you have injured a Spinal ligament.  What is the Anterior Longitudinal Ligament?  What is the role of the Anterior Longitudinal … Continued


  • What Is the Alar Ligament?

    Introduction Medicine is highly specialized now.  Each specialty has a series of checkboxes that patient’s symptoms nicely fit into.  For example, irregular heart rhythm with abnormal ECG is a cardiology problem.  Shortness of breath with abnormal chest x-ray can be effectively evaluated and treated by a pulmonologist.  Unfortunately, the symptoms and presentation of patients with … Continued


  • Understanding Cervical Spine Instability Measurements

    Cervical Spine Instability Measurements: How To Precisely Interpret Them It was all a blur. You were waiting for the red light to change when a large truck slammed into your vehicle. You did not see the approaching vehicle but heard the skidding tires.  The brain fog, dizziness, and fatigue have not responded to conservative therapy.  … Continued


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