Rotator Cuff and Capsular Injuries

Shoulder Pain

Do you know someone that has injured their shoulder? Throwing athletes such as volleyball, baseball or softball players, tennis, javelin throwers, racquet ball or quarterbacks to name a few, comprise a younger group of people that injure their shoulder playing sports. Usually a rotator cuff tendon get injured and causes the pain. But, did you know that they are usually a secondary injury? The initial injury is the capsule of the joint. The capsule encases the joint 360 degrees around it. It allows the humerus (arm bone) to hang on to the glenoid (the wing bone). The capsule is redundant, meaning that the lower portion has folds built into it, which stretch out when the arm is above your head. The injury that throwing athletes have that sets them up for the rotator cuff tear, occurs at the lower portion of the capsule. This is called the inferior gleno-humeral ligament (IGHL) which gets stretch out when the athlete’s muscles fatigue with repeated throws. A muscle, the latissimus dorsi (lat for short) acts as a break and helps decelerate the arm after the ball is released. If the lat is fatigued or tired, it doesn’t do its job and the capsule then acts as the break. When this occurs over time, the capsule gets stretched out or even torn. This may go unrecognized even after the rotator cuff tendon is noted to be injured. The capsule, if stretched, allows for a greater range of motion of the shoulder joint. The humerus then migrates up and comes into contact with a piece of the shoulder blade, called the acromium. When this occurs, the supraspinatus tendon, one of the four rotator cuff tendons, is squished. If the tendon is squished and the arm moves, the tendon can tear.

An MRI or Ultrasound can be used to diagnose a tear. If surgery is offered, the tendon is what is treated, but not the original capsular injury. This is the reason why many people who have had their rotator cuff treated with surgery, re-injure the rotator cuff later. The original injury was not treated. Prolotherapy and Platelet Rich Plasma offer non-surgical treatment for the entire shoulder injury-the rotator cuff injury and the capsular injury, thereby improving your long- term benefits. The benefit with being treated with these non-surgical treatments is that you don’t lose time from work. Alternatively, if your rotator cuff is fully torn, surgery may be the best option for treatment. Consider treating the capsule and IGHL either before or after the surgery.

With lifetime use, rotator cuff injuries can occur slowly. If the joint migrates too far off its center axis, over time the cartilage can wear down leading to arthritis. The term we use to describe a joint that moves too much is a hypermobile joint. Some people are born with increased range of motion of a single joint, occasionally all the joints in their body are hypermobile. The treatment may be very similar, for hypermobile joints that lead to arthritis or for patients that experience pain as a consequence of having collagen issues leading to pain from hypermobility. The treatment may be prolotherapy or Platelet Rich Plasma (PRP), however the areas that are treatment may differ slightly. Treatment with either of these has two purposes, the first being to stabilize the joint so it doesn’t move out of alignment (improve function) and the second is to decrease pain.


Dr Stebbing's best selling book walks patients thru the process of what they will experience when they work with her. Dr Jennifer Stebbing DO Founder of Musculoskeletal and Sports Medicine, Dr Jen is passionate about figuring out a solution to your pain. She is familiar with pain and the emotional costs, physical costs, relationship costs, energy costs that pain has on people. She avidly invests in her own health and wants you to do the same.

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