Treating the most common skiing injury: a torn rotator cuff

According to a recent study by the Division of Sports Medicine at Stanford University, the most common injury from skiing and snowboarding is damage to the rotator cuff – whether a simple strain or tear. This is typically as a result of falling and crashing or incorrect pole planting.

But for the purpose of this post we are focusing on the most common shoulder injury. Here, Orthopaedic Surgeon Mr Peter Reilly explains what the rotator cuff is, the type of injury it can sustain, the clues to understanding if you’ve damaged your rotator cuff and the possible treatments.

What is the rotator cuff?

The rotator cuff is a group of four muscles that join the shoulder and upper arm. These muscles provide stability to the shoulder joint and aid movement.

The four muscles include the Infraspinatus, Subscapularus, Supraspinatus and Teres Minor.

How to tell if you have torn your rotator cuff

A rotator cuff injury may vary from inflammation to small splits to more serious tears. Symptoms of a torn rotator cuff include:

• pain
• weakness
• restricted motion
• clicking or catching when moving your shoulder

The intensity of the pain can depend on your level of activity. For instance, reaching above your head or behind your back can result in sharp pain. You are also likely to experience pain during routine activities such as combing your hair. Sleeping on the affected side may also hurt.

However, it is possible for someone with a torn rotator cuff to experience no pain, only weakness in the joint. It is not always easy to tell if you have torn your rotator cuff, so seek medical advice if you feel weakness in the joint after a fall on the slopes.

Ski falls may also cause undisplaced fractures which are often not seen on x-rays, requiring an MRI scan. This type of injury typically does well with an appropriate rehabilitation programme rather than surgery.

How does the rotator cuff get injured while skiing?

Injuring your rotator cuff while skiing is typically a result of trauma, but acute or chronic use can also result in a torn rotator cuff.

Even the best skiers fall, and it’s natural to reach out your arms when you do. But doing so means that the impact strikes your arm and passes up to your shoulder, which can result in injury.

The impact can put pressure upon your shoulder joint, twisting it and causing tears or even ruptures in the muscles and tendons. And while the speeds at which you travel while skiing are thrilling, they also mean that the impact of a fall is much more likely to cause injury. Even a low-speed fall has the potential to cause injury.

It’s also possible to injure your rotator cuff over time. Repetitive actions such as pole planting can wear down the muscles, leading to an injury that is less dramatic but no less painful.

Treating a rotator cuff injury without surgery

A torn rotator cuff can become worse over time, so it’s important to seek treatment. While surgery may be recommended, it’s possible to treat a torn rotator cuff without surgery.

You may be able to treat your injury if it is minor and you don’t regularly perform strenuous exercise with your shoulders. Anti-inflammatory medicines and steroid injections can help to relieve the pain while you strengthen the joint with physiotherapy. While rotator cuff tears do not usually heal themselves, this treatment can give you back the use of your shoulder for day-to-day life.

However, treatment without surgery is not usually appropriate if you’re an active person, which you probably are if you ski!

Treating a torn rotator cuff with surgery

Rotator cuff surgery is recommended if:

• you use your arm for overhead work or sports
• if the pain or weakness persists after non-surgical treatment

The procedure delivers a number of benefits, including:

• pain relief
• Improved shoulder stability
• Increased strength and range of movement
• Increased ability to use the joint

Rotator cuff surgery involves reattachment of the torn tissues to the bone. Key-hole and open surgery may be performed depending on the nature of the injury.

Once the surgery is complete, you will likely spend a night in the hospital before you are discharged. Your surgeon will advise you whether you should keep the joint still or begin gentle movements. Either way, you will need to wear a sling for around 6 weeks, and you will need to undergo physiotherapy to gradually strengthen the joint again.

It will take some time before you are able to use your shoulder again properly. But you should be able to return to work in around 4 weeks (if you have a manual job, you may not be able to return to work for 4-6 months). You should be able to drive again after 8 weeks.

More information

• If you plan to go skiing, learn more about ski injuries and how to avoid them.
• If you’re suffering with shoulder pain, speak to your GP about a possible referral to a specialist.
• If you don’t have a GP, you can make an appointment with one of our same day private GPs.
• Our Physiotherapy Department is fully equipped and staffed by experts on hand to help you back to full shoulder mobility and function.
• Our Orthopaedic Surgery Department is a world famous centre of excellence for all orthopaedic surgeries including shoulder surgery. To enquire about shoulder surgery and see one of our experts, contact us.