Rotator Cuff Tear
Rotator cuff tears are injuries to the tendons that surround the shoulder joint.
Rotator Cuff Tear
Many sports involve repetitive arm motions that can take a toll on the rotator cuff tendons that surround the shoulder. The shoulder is a ball and socket joint that is composed of the humerus bone in the upper arm, the scapula, and the clavicle. The shoulder joint is surrounded by four tendons that make up the rotator cuff. These tendons attach to muscles that are in charge of lifting and rotating your arm. The four tendons are the supraspinatus, infraspinatus, subscapularis, and teres minor. Any of these tendons can be involved in a rotator cuff injury.
Rotator cuff tears may develop because of an acute injury such as a fall, a sudden jerking motion of the arm, or putting the arm out to catch something heavy. Other tears are caused by age-related degeneration or chronic impingement (rotator cuff tendons being pulled and squeezed under the coracoacromial arch). Regardless of how the tear occurs, patients generally present with pain in the shoulder that oftentimes disturbs their sleep at night. They may have pain and weakness with any overhead activities. Athletes affected by rotator cuff tears are likely unable to achieve peak performance due to pain and weakness. Sports that require extensive arm and overhead motion may be near impossible to play in some cases. In rare cases, if the tear is massive the patient may be unable to lift the arm above shoulder height. This is called pseudoparalysis, meaning the arm is essentially “paralyzed” because the muscle in charge of lifting the arm is no longer intact.
If you are experiencing any or all of these symptoms mentioned, you should come to our office for an evaluation. Our doctors will take the time to examine your shoulder in detail and discuss your limitations and pain points. They may order further tests or imaging to help them establish a diagnosis. Generally if they are suspicious of a rotator cuff tear they will send you for a shoulder MRI.
Cuff tears can be diagnosed clinically, but an MRI may be used to determine the extent of the tear and further management. An MRI allows your doctor to see cross sectional images of the shoulder and the surrounding tissues. Our doctors will ask that you bring a copy of your MRI to your appointment so they can personally review the images. They will be able to look through the images with you and show you the source of your pain and the extensiveness of your injury.
You may have a partial thickness tear of one of the rotator cuff muscles, meaning the tendon is only somewhat torn. Sometimes, these can initially be treated with conservative management. This includes physical therapy, NSAIDs and activity modification. Physical therapy can often strengthen the surrounding muscles and alleviate or eliminate the pain. Usually if physical therapy is prescribed, our doctors will recommend that you stick with it for at least 6 weeks to see if it actually makes an improvement. Oftentimes, patients are surprised by the improvement they have with physical therapy and they can return to their sport stronger than before. Other patients do not have success with conservative management and they may be a candidate for an arthroscopic rotator cuff repair. Generally, our doctors like to avoid cortisone injections for rotator cuff tears because the cortisone can weaken tissue that is already compromised. Although you may feel short term relief, the long term effects may be detrimental. There are exceptions to this and everyone’s case is treated differently depending on a variety of factors.
If you have a partial thickness tear and have failed with conservative management or have a full thickness or massive rotator cuff tear you will likely need surgery. Our doctors perform the vast majority of their rotator cuff surgeries arthroscopically. Shoulder arthroscopy involves introducing a small camera and instruments into the shoulder joint through a series of small incisions to examine different parts of the shoulder. This may oftentimes be both diagnostic and therapeutic.
Arthroscopy allows the surgeon to visualize the labrum, biceps tendon, capsular ligaments, undersurface and superior surface of the rotator cuff, the glenoid, humeral head, and subacromial space. Debridement and repair of the rotator cuff can be done through the small portals made in the shoulder. Rotator cuff repairs involve returning the torn tendon to its native location with the use of anchors placed in the bone and sutures drawn through the torn end of the tendon. The overall goal is to restore normal function and stability while eliminating pain.
Rehabilitation following a rotator cuff repair is very important. For the first six weeks after surgery, you will have to rest your shoulder in a sling with very limited shoulder motion. The rotator cuff tendon will take about six weeks to heal down to the bone. It is very critical that the restrictions during this time are taken seriously, if not you could risk compromising the repair that was done. Once the six weeks have passed, you may begin gentle range of motion exercises with formal physical therapy. Your therapist will guide you through specific motions and exercises that are prescribed by your doctor. You must wait at least three months before it is safe to do any kind of resistance or strengthening exercises. The entire recovery process is a lengthy one and may realistically take anywhere from six months to one year after surgery.
Rotator cuff injuries can cause serious setbacks for any athlete. Our goal at Modern Orthopaedics is for you to return to your sport better than before. This may take time and patience, but we want you to experience a full recovery. We understand that each athlete and sport is unique and we will develop your treatment plans accordingly. We want to understand your goals and help you reach them. Please contact our office to have an initial evaluation for shoulder pain and receive superior care from our doctors and staff.
Frequently Asked Questions
Most shoulder pain can be treated with rest, anti-inflammatories and physical therapy. Any primary doctor or general orthopedist can prescribe these simple solutions, but a trained shoulder specialist won’t just treat your pain — they will diagnose and treat your specific problem.
At Modern Orthopaedics, our trained shoulder specialists will ask the right questions, perform specific examinations and order imaging when appropriate. They will be able to diagnose your problem and treat you whether your problem is simple or complex. Although you may not feel like your shoulder issue is “bad enough” to see a specialist, it is advantageous to have the opinion of an expert in the field when it comes to your health.
If you have been diagnosed with a “rotator cuff tear,” that can mean many different things depending on the severity, location, chronicity and dysfunction it is causing. Many times, a small or partial tear can be found on an MRI, but a patient may not even have symptoms. We treat the patient and not the MRI findings. That being said, MRIs can be very helpful in diagnosing a tear, and imaging gives us the ability to visualize the location and extent of the tear. With that information, we can come up with the best treatment plan. Thankfully, most people who have a rotator cuff tear on an MRI do not need surgery, but many people do. We are here to help, whether you just need a few sessions of therapy or you need surgical intervention.
As our patient, you will have an in-depth consultation with one of our doctors. We will create an individualized treatment plan together, tailored to your problem and lifestyle. Our doctors prefer non-invasive treatments whenever possible, including physical therapy and/or injections. If your problem ultimately does require surgery, our doctors prefer the least invasive surgical techniques possible. Our goals are the same as yours: to get you back to living your best life, pain free.