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.