By Dr. John C. Kagan, M.D.
Rotator cuff tears are some of the most common causes of pain among adults in the United States. Torn rotator cuffs lead to shoulder weakness, which can make it difficult to complete daily tasks like getting dressed. Depending on the type and severity of the rotator cuff injury, surgery may need to be performed to alleviate symptoms and restore full range of motion.
The rotator cuff is made up of four muscles that are joined with tendons to create a covering around the head of the humerus bone at the top of the arm. A rotator cuff tear occurs when one of the tendons are torn, no longer fully attaching to the humerus. There are multiple types of rotator cuff tears, including a partial tear, which damages the soft tissue but doesn’t sever it, and a full-thickness tear, which splits the soft tissue into two separate pieces. The full-thickness tear is essentially a hole in the tendon.
Common symptoms of rotator cuff injuries include pain and weakness, while lifting and lowering the arm in specific movements, a crackling sensation when moving the shoulder, and pain at night. While sudden injury, such as a fall, may be an obvious reason for pain, rotator cuff tears can also develop slowly over time due to overuse and over-rotation of the shoulder.
Because of the nature of these wear-and-tear injuries, people over the age of 40 are most at risk of rotator cuff injuries. Others at risk include those whose occupations require them to do work above their heads, such as painters, plumbers and carpenters, and athletes such as tennis and baseball players, whose repeated motions can cause damage. While the pain may start out being manageable with over-the-counter medications and rest, small tears often grow larger and more painful before they have a chance to heal on their own. A decrease in blood supply to the tendon also decreases with age, which inhibits the body’s ability to repair small tears.
If you suspect a rotator cuff injury, your physician will diagnose the issue by having you move your arm through a wide range of motions and will check for tenderness, deformities and overall arm strength. Your doctor may also examine your neck closely to ensure the pain is not being referred and to check for arthritis and other conditions. Imaging tests such as X-rays, MRIs or ultrasound may also be used to diagnose the problem.
Depending on the severity and type of the rotator cuff injury, nonsurgical treatment may be an option. Nonsurgical treatment options include rest and limited motion, over-the-counter pain medications such as naproxen sodium and ibuprofen, physical therapy, and injection of steroids such as cortisone at the site of the tear. While nonsurgical treatment options avoid the risks of surgery, which include infection, stiffness, and lengthy recovery time, they can also be limited in their effectiveness and may require permanent limitations in enjoyable activities, such as tennis, which exacerbate the injury.
Surgery may be the best option to restore full motion and relieve pain from rotator cuff tears. Depending how long and complex the tear is, the surgeon may be able to perform arthroscopic surgery, or they may need to make a regular incision. A third option, mini-open repair, uses new technology to repair the rotator cuff through a smaller incision than traditional surgery.
Regardless of the type of surgery performed, rehabilitation and physical therapy are essential to restore strength and motion. Your arm will likely be immobilized in a sling for the first four to six weeks following the surgery. Once the surgeon decides it is safe to move the arm, a physical therapist will guide you through a series of passive and active exercises. Complete recovery will likely take four to six months, but with proper rehabilitation, you can expect relief from pain and full use and strength of your arm and shoulder.
If you have concerns about rotator cuff injuries or other orthopedic disorders, Dr. John C. Kagan and his staff are ready to answer your questions. Dr. Kagan has more than 30 years of experience as an orthopedic surgeon and sports medicine specialist treating patients in Southwest Florida. He specializes in treating patients with knee, shoulder and hip pain, as well as general orthopedics and hand surgery. For more information, visit www.kaganortho.com or call 239-936-6778.