Piano World Home Page Forums Our Most Popular Forums Piano Tuner-Technicians Forum Torn Rotator Cuff

I don't know if piano techs are particularly prone to a torn rotator cuff, but regardless of the cause, I imagine it would be an unwelcome disruption to one's work and income. I recently learned of the following potential alternative to surgery. Perhaps it will benefit someone.

In a study of 452 rotator cuff tear patients, this exercise program spared an impressive 85% of them from surgery. The Rotator Cuff Home Exercise Program information is free:

http://moonshoulder.com

http://moonshoulder.com/booklets/060109PatientRehabBooklet.pdf

http://moonshoulder.com/booklets/Therapist%20Directed%20Cuff%20Rehab%208.12.pdf

http://moonshoulder.com/MOONRotatorCuffRehab.mp4

David Bauguess

I remember Jerry Groot telling me he had a torn rotator at one point. Caused him a lot of pain and trouble.

I've had both cuffs torn and I believe it came from shoving heavy pianos all over the place. I changed my diet, ate lots of Asparagus ( something about the fibers) and took Ostio-Biflex or glucosomine for about a year. I am still doing the heavy lifting but do not have issues anymore. No surgery.

You will have more trouble at rest or while sleeping with extreme pain with a rotator cuff issue.

Cortisone shots - given by an orthopedist - not your MD.
A 50% improvement within 24 to 48 hours and back to normal in 3 to 4 days.
No surgery.
Stop tuning funky old uprights that are over 100c flat with loose pins and false beats - or get an impact hammer if you must.

They can be very effective. A note of warning though, if you have diabetes, think very carefully if you want to go this route. Blood sugar control is very difficult after cortisone shots and you will feel like the "cure" is worse than the disease for a while. Also cortisone doesn't work for about a third of people.

That kind of blanket statement is a prime example of a little knowledge being dangerous. First of all, there are different grades of rotator cuff tears, and the more serious will require surgery. Secondly, if you understand the underlying cause of 99.9% of these tears, which is MECHANICAL in nature, you realize that, while you may get temporary relief from the introduction of a very powerful anti-inflammatory like cortisone into the glenohumeral joint, this does NOT address the MECHANICAL reason for the /shearing/tearing of the muscles and tendons of the cuff. So, the symptoms are being masked while the mechanical damage continues. As we get older, the rotator cuff, which is already poorly vascularized as compared to other joints, gets less adequate blood flow, and, thus, less oxygenation and nutrition to the tissues. It is also a very tightly packed joint with little free space above these tissues, especially in overhead movements of the arms. The primary function of the rotator cuff, aside from internal and external rotation of the humerus, is to counterbalance the force of the deltoid muscles as they raise the humerus up overhead. So, as the deltoid creates an upward force on the humeral head, the rotator cuff SHOULD be creating an equal and opposite DOWNWARD force to hold the humeral head stable in the glenohumeral joint. Trouble is, most people, over their lifetime, develop a huge strength imbalance between the deltoids and the rotator cuff, resulting in the humeral head rising up and impinging the rotator cuff tissues, (tendon and muscle), between it and a bony prominence called the "acromion". Add to this the fact that many people have genetically malformed versions of this acromial bone, (which is part of the scapula), which further exacerbates the MECHANICAL problem. The bottom line is that the constant impingement of these soft tissues between these two bones, along with the poor circulation to these tissues as we age, results in micro tears and chronic inflammation that eventually will increase the damage if left untreated. Cortisone helps initially ONLY in breaking the chronic inflammation cycle for a while, BUT, it is so powerful that it has very strict limits on how many times it can be used, AND, it does NOTHING to address the original source of the problem. For that you need MECHANICAL intervention.....in the early stages, that equates to Physical Therapy to do three things....increase the available space in the joint to eliminate the impingement between the humeral head and the acromion of the rotator cuff, strengthen the rotator cuff muscles to better counteract the force of the deltoids in lifting the arms overhead, and educating the patient on posture and motions that are feeding into this problem. When the tear is too severe, or the acromion too genetically malformed, surgery is the only effective intervention, with the above physical therapy implemented post op.

Greetings,
I think I can speak with some authority here, as I have had four rotator cuff operations and three acromioplasities. I had way too much deltoid for the cuff! One of these operations will take you off the pianos for three months, and the pain is considerable, all through rehab.
If you have already torn sufficient cuff muscles, and decide to avoid surgery with glucosimine and rubber bands, consider that an unstable joint will allow the bone to damage the cartilage (labrum). After this cartilage is gone, you are past the point of return, and there is nothing to do but suffer, or attempt one of the shoulder replacement surgeries, (which my Dr. has told me is not much better than nothing). Before placing faith in the excercises, (which I do daily, and will have to do forever...) I suggest you have it medically examined so that the joint isn't needlessly ruined.
Regards,

CC2, thanks for the in depth info on this. I have been researching this topic for a while and your post kind of put it all together with the gaps filled in. I have just messed up my left rotator cuff about 6 months back and been on a slow road to recovery since. I do a series of light exercises/flexing to rehabilitate it and take some iboprofin to help reduce and break the swelling/inflamation.

One thing I learned from all this is that it really helps to learn how to tune with both arms equally well. I did not have an issue or slow down with my work because of this injury because of this. Rotator cuff injuries are one of the worst things to get as far as speed in recovery, or for some people, recovery at all.

One of the odd benefits of this injury is that it can force the sufferer to adapt a better overall posture with their shoulders and back. The forward rounding of shoulders as we age does not lend itself to helping with free movement of the muscles and tendons within the joint.

You are quite welcome Emmery. Your comments regarding postural improvement are spot on. After over a third of a century of rehabbing every possible type of musculoskeletal injury, I can tell you that 99% of them are driven, or worsened, by placing the joint in a mechanically disadvantageous position, (poor posture), that creates excessive stresses and wear and tear on the joint tissues, and muscular imbalances that create joint instability. This is probably why piano technology was such a good "fit" for me as a second profession. The same forces of leverage, friction and inertia that guide the function of the musculoskeletal system apply to the function, or malfunction, of the piano's action.