Rotator cuff injury alternate therapies?

Hey Gang,

I’ve been dealing with some shoulder pain and weakness for some time following a minor injury. This was likely preceded by a previous injury many years ago. Saw a sports ortho PA who prescribed eights weeks of PT, which yielded no significant improvement.

A subsequent MRI indicated minor - moderate tendoniopathy and split/partial tears of various tendons, ligaments, and some minor arthritis. PA is sending me to a surgeon for an opinion, but earliest appointment is a month away.

Dr Google said there are additional therapies available like shockwave, PRP injections, and tendon scraping. Corticosteroids are contraindicated for me. Has anyone used these therapies? Did you have to find a specialized PT? How were the results?

TIA,

Dan

hey Dan, dealt with a similar situation a couple years back — partial tears, PT didn't do much after the first round. couple things from my experience:
shockwave therapy was actually helpful for me, did about 6 sessions over 3 months. its not a miracle fix but combined with a more targeted rehab program it made a noticeable difference. the key was finding a PT who actually understood climbing loads, not just generic rotator cuff rehab. PRP i looked into but skipped because the evidence is still pretty mixed and it wasnt cheap. a climbing physio i talked to said he's seen good results with eccentric loading programs (think slow negatives with light resistance bands) which is basically free and worth trying while you wait for the surgeon appointment.

I have done all those therapies while having similar clinical findings as you. I had no specific previous injury though just chronic overusage. Retrospectively, Since your situation seems to fall into the chronic category?, I would advise strongly against corticosteroid injections since these are merely a band-aid that will allow you to worsen the damage without pain feedback and most Docs won't do surgery until >3 months after an injection.  In my case, the tendinopathy was significantly improved by finding a climbing specific Doctor of PT to assess which compensatory muscles were overactive and which needed to be reactivated. The PT also helped to develop a plan using "reps in reserve" to load the tendon just enough to allow proper collagen restructuring but not too much to allow the damage to continue...Kind of a combination of eccentric loading while using daily pain readings as a guide. Anyway, I already had surgery on my one shoulder and about to have the other done but the climbing PT bought me a couple years of climbing moderately hard till the surgery was inevitable. Still, just understanding how the shoulder works and having a solid go to "maintenance PT plan" was the most helpful for myself after surgery.  Hope this helps and this is just one example and everyone is different. Feel free to dm me with questions. I know how frustrating it can be due to the complexity of the joint and that we don't like to stop climbing. Good luck. 

Thanks for the responses. I’ve reached out to a climbing specific PT in my area.

Get surgery.  You won't regret it.

Steve Williamswrote:

Get surgery.  You won't regret it.

I have a trip to the Cordillera Blanca planned for June. I have planned this trip every year since 2020 and every year something happens to derail it. I. Am. Going. To. Mfing Peru. This. Year.

Then find a good physical therapist and have them help you work on it.  Then after your trip if you're still having issues, 

get the surgery.

Daniel Patrick Smithwrote:

Hey Gang,

I’ve been dealing with some shoulder pain and weakness for some time following a minor injury. This was likely preceded by a previous injury many years ago. Saw a sports ortho PA who prescribed eights weeks of PT, which yielded no significant improvement.

A subsequent MRI indicated minor - moderate tendoniopathy and split/partial tears of various tendons, ligaments, and some minor arthritis. PA is sending me to a surgeon for an opinion, but earliest appointment is a month away.

Dr Google said there are additional therapies available like shockwave, PRP injections, and tendon scraping. Corticosteroids are contraindicated for me. Has anyone used these therapies? Did you have to find a specialized PT? How were the results?

TIA,

Dan

I tried the "alternative" route first too, PT, exercises, rest, even shockwave once. None of it really fixed the instability in my shoulder. Pain would calm down for a bit and then come right back when I used the arm normally.

Eventually I was treated by Dr. Steven Thornton because the MRI showed a partial cuff tear and frayed tendon tissue. The procedure was arthroscopic, they repaired the damaged tendon and smoothed the irritated areas inside the joint.

Recovery wasn’t instant but after rehab the shoulder finally regained strength and I could lift again without that constant dull pain.

Daniel Patrick Smithwrote:

I have a trip to the Cordillera Blanca planned for June. I have planned this trip every year since 2020 and every year something happens to derail it. I. Am. Going. To. Mfing Peru. This. Year.

If you are climbing and your shoulder goes to hell and your partners trip is ruined- good choice.

In my experience shoulders don’t heal, for climbing anyway, using only PT.

Good luck with it, enjoy your trip. 

I have 40-50% internal tears in the supraspinatus tendons- proper physio is a must. I also get PRP from Regenexx 1 to 2 times a year and monthly injections of proletherapy. All this enables me to keep climbing at max effort. If I stop climbing my body heals itself but this is not a solution. I found this out from enforced rest from mountain biking injuries to the lower body and the elbow . PRP is expensive but worth it but the reduced inflammation only last, for me, for about a year probably because I start climbing too soon. I would recommend the proletherapy as a much cheaper but pretty good alternative with physio that you never stop doing