Rotator Cuff Injury

Mark: Hi, it's Mark from Top Local. I'm here with Wil Seto of Insync Physio in Vancouver. One of the best physiotherapy shops in Vancouver, multiple time winners of best physiotherapists in Vancouver and their star, their owner, Wil Seto who's many times voted the best physio in Vancouver as voted by his customers. And we're going to talk about a real common issue, traumatic rotator cuff injuries. Wil how are you doing? 

Wil: Yeah. Hi Mark. I'm doing great. Thanks for having me on today. So yeah, rotator cuff injury. So when we talk about rotator cuff traumatic injuries, they can obviously be quite worrisome and when you have that happen, you're kind of left wondering, you know, like what should I really do about it? 

Mark: So just for those who might not know, rotator cuff, that's a real common term we heard about it in baseball. What is the rotator cuff? 

Wil: Yeah excellent question. So we like to refer to it as like a rotator cuff interval, but to keep it simple, like when we think of rotator cuff, it's primarily composed of four muscles and tendons that attach onto the arm or in the shoulder joint.

And, so, you know, I don't want to complicate it too much, but basically the names of them, there's four of them and have your supraspinatus, infraspinatus, teres minor and subscapularis. So you have the four rotator cuff muscles that basically, what they do, is they act like a suspension bridge. So if you think of like, you have those four muscles and they, create this like ability to stabilize your shoulder because your shoulder has this 360 degrees of motion and movement, right. So that's the primary function. Then you also have your capsule and your ligaments that are intimately connected with that.

Mark: So when you injure your rotator cuff, you basically you've hurt your shoulder, doing something with your arm and shoulder, basically. 

Wil: Yeah, exactly. So I see this a lot and you know, many different sports, but one in particular, who was a gentleman that, had a fall from skiing. And I mean, he's quite an athletic gentleman to begin with and he does rock climbing, but his specific thing that he did, he actually fell down skiing like from last year. And it really struck me because I remember like he came in and, you know, he did have some limited range of motion and he definitely was, a kind of person that was very functional to begin with. you know, like right after the injury.

And so he really wanted to get better at fast. He was always pushing it. There are specific tests that we do to really pinpoint and really isolate, okay you know what part of the rotator cuff? And so when we looked at his shoulder, you know, definitely had  all the compensation issues already right away, that was going on, like just, you know, his lats and his pecs were kicking in. And so certain muscle imbalances were already there. Whether they were preexisting, but definitely I think it was because of the injury. And, ultimately, what we wanted to do, is we wanted to do more of the conservative measure in terms of taking them through the physio portion of it and looking at range of motion, getting his motion back, looking at getting his strength. And really starting to hone in on activation of that rotator cuff. 

Talked about the rotator cuff is, if you think of the four of them, it's like a suspension bridge. And when one of them is injured, then now you have this imbalance, so then now it poles differently and so we want to try and get that other one that's been injured to heal and to kind of get that working properly. And then all the other ones sort of follow suit as well. And then kind of just be able to provide this what you call dynamic stability in that whole shoulder joint. Because the shoulder, what makes it really unique is that, like I was saying, it provides you this 360 degrees of movement.

If you can imagine like a baseball, you know, sitting on a golf tee, right. And then you have all this cartilage that, kind of makes it a little bit deeper. So the bowl, but then it needs to be stabilized by muscle because it's not like your elbow or your knee where you have a stop right there where you can, you know, be able to limit your range. And that's why it's more like the 360 degrees type of motion. 

And then there's a lot of other factors to consider with regards to, you know, looking at the muscle control round the whole shoulder blade. So if you have, all this compensation going on, when you have an injury, then you have to address that. So we won't try and normalize that. 

So, basically the first three or four sessions, we really, we looked at normalizing things and then trying to get the motion back and get the activation patterns. And quite honestly, if things weren't progressing well or they're progressing quite slowly, then I would refer over to a specialist like one of our sports medicine physicians that we have in the back of our pocket, so to speak who really likes to take on clients of ours and we can get them in to see them pretty quickly. And so that's a real benefit to be able to do that, because then they're able to get through the process and I communicate with them. I work with the sports medicine physician to be able to expedite certain things and to look at, you know, do we need to get a scan, like an MRI or something like that. 

So it, it happened to be that this person needed that, you know, his progress was really slow and it turned out that he had a full on thickness tear. It was like a pretty large, like more than three quarters of his rotator cuff was torn. And so they decided to operate because it was, you know, definitely the weakness part of it. That's where you really find, you know, that this dysfunction, he wasn't complaining of pain very much other than the fact when it limited his motion. But the reason why he couldn't go all the way up was because when we tested him and obviously the strength was really poor. 

So, he ended up getting somehow fast tracked when we got them to see the sports medicine physician. He had surgery. And so the surgery was the thing that he elected to do because he's very active and he wanted to be able to rock climb and ski and all that stuff. And that was actually a year ago. 

So, you know, and I've seen him since, and he's actually back rock climbing and skiing again without any problems, but that's been a full year of rehab for his surgery. So it's been really a success story in that way.

Mark: So if you fallen on yourself and you find that you got a lot of pain in your shoulder, if you've injured it playing some sport or recreational activity, or it could even happen in a car accident. The guys to see are Insync Physio, they're experts at getting you back moving properly in your life. Reach them at their Vancouver office (604) 566-9716 or in North Burnaby, (604) 298-4878. If you want to book online, you can do that at their website It's really simple to use, and it will get you able to pick whichever physiotherapists you want to see. Thanks a lot Wil. 

Wil: Thanks Mark.