The rotator cuff is a group of four tendons and muscles that stabilize the shoulder joint and allows the arm to move. The muscles and tendons making up the rotator cuff hold the arm in place while allowing it to move in different directions. Another function of the rotator cuff is to help hold the “ball” of the upper arm bone in place in the shoulder socket. This ball and socket joint of the shoulder has the greatest range of motion of all the joints of the body, which also makes it prone to instability. The tendons in the rotator cuff are often damaged from overuse or injury. A tear to the rotator cuff is similar to a tear in a piece of leather, and it can be damaged by varying degrees. If the tendon is only slightly damaged or irritated, it can usually be repaired without surgery. However, the rotator cuff can also be completely torn if it completely tears away from the bone. Rotator cuff tears are not life-threatening, but they do limit movement and can cause significant pain and stiffness. Chronic shoulder and arm pain isn’t something you have to live with, especially as symptoms get worse. You can get back to your normal routine much more quickly by seeking early treatment. Treatment for a torn rotator cuff can improve debilitating symptoms of pain, weakness and lack of mobility.
Rotator cuff injuries are fairly common and can be a result of tendinitis, bursitis, normal wear and tear of aging, falling, lifting or pulling, and repetitive stress. The rotator cuff may become partially or completely torn for the following reasons:
- Tendinitis – When tendons become inflamed from overuse or because they have been over loaded it is referred to as tendinitis. This is very common in athletes who preform many repetitive overhead activities.
- Bursitis – Small fluid filled pads that act as cushions called bursae located in the joints can become inflamed, which results in a condition called bursitis. Bursitis often occurs in joints that preform many repeated motions.
- Normal wear and tear – After the age of 40 it is quite common for people’s rotator cuff to become damaged as collagen breaks down in the tendons and muscles. This makes the area to be at a higher risk of injury. Also as people age they can develop calcium deposits which can pinch or irritate the rotator cuff.
- Falling – When people fall they often use their arms to help break the fall or to try and catch themselves. This sudden shock can easily bruise or tear a tendon or muscle in the rotator cuff.
- Lifting or pulling – When lifting or pulling something at is too heavy or improper lifting can damage the rotator cuff, especially if the motion was with a person’s arms in the air.
- Repetitive stress – Repeated overhead movement of the arms can lead to inflammation and the eventual tearing of the rotator cuff. This injury is most often seen in athletes like baseball pitchers, swimmers and tennis players or workers like painters and carpenters.
Rotator Cuff Injury Symptoms
The signs or symptoms of a rotator cuff injury may include:
- Shoulder weakness when lifting or rotating the arm
- Loss of shoulder range motion
- Pain or tenderness in your shoulder, particularly when reaching overhead, behind the back, lifting, pulling, or sleeping on the affected side.
- Crackling sensation as the shoulder is moved in certain positions
Sudden tears may cause immediate, intense pain accompanied by a snapping sensation and upper arm weakness, while tears that come on gradually take more time to be noticeable and bothersome.
During a physical examination of your shoulder, your doctor will ask about your symptoms and take a complete medical history. While examining your shoulder, the orthopedist will check for deformities and ask where the shoulder feels tender. Your doctor will ask you to move your arm in different directions to test range of motion, and arm strength will be checked. Other conditions will be ruled out before making a rotator cuff tear diagnosis, such as a pinched nerve mimicking the symptoms of a rotator cuff injury. Arthritis may also be to blame for shoulder pain. A diagnosis will be confirmed upon viewing imaging tests such as X-rays and MRI scans or ultrasound. The doctor will look for bone spurs, tendon tears, and the quality of the muscles. These tests may also reveal how long you have had the tear, as well as the location and size of the tear. Your diagnosis and the specific factors of your tear will determine treatment.
Rotator Cuff Treatment
Your treatment plan will depend on your age, activity level, health status, and specific characteristics of your rotator cuff tear. The goal of treatment is to relieve pain and regain strength and function of the shoulder. About half of patients recover from nonsurgical treatment alone. One of the benefits of nonsurgical care is that you avoid the risks associated with major surgery, but a disadvantage is that the tear may still increase over time. Many doctors recommend pursuing nonsurgical care first to see if it relieves pain. However, shoulder strength usually cannot be improved without surgery. Nonsurgical options include:
- Physical or occupation therapy - A therapist may be able to help you gain more mobility in the shoulder through a variety of exercises. Strengthening exercises can help the shoulder muscles and prevent further injury.
- Activity modification - If you perform certain sports or work tasks which aggravate the shoulder, such as frequent overhead movements, your doctor will advise you to limit or avoid these. A sling may be given to you to help protect he shoulder and immobilize it, temporarily.
- Medication - medicines such as ibuprofen may be useful in relieving swelling and pain.
- Injections - Corticosteroid injections directly into the joint is very effective in reducing swelling and pain, but must be repeated to achieve the same effect.
You may be a good candidate for surgery if your problem does not respond to conservative methods, or if you have a tear that is larger than 3 centimeters. Patients who have marked weakness and loss of function, or if the injury came from a sudden injury, may also be suitable candidates. If an orthopedic surgeon determines that the damage can be repaired, they will perform a surgery to clean out the inflamed or damaged tissue and might need to remove any bone spurs if they are present. This surgery can be done arthroscopically using a small camera and several small incisions. The goal of the surgery is to attach the tendon back to the bone using sutures or sometimes rivets called suture anchors to help. The suture anchors are often made with metal or a material that will dissolve over time so they do not need to be removed. At the end of the surgery, the incisions and closed and bandaged and often pictures or videos are shown to let the patient see the repairs made. The three types of rotator cuff repair surgery include:
- Arthroscopic Surgery: Through the use of only small incisions, the orthopedic surgeon introduces a tiny camera and surgical instruments to view the anatomy of the area on a monitor in the operating room and repair the tear.
- Open Surgery: A larger incision is made to view the shoulder structures directly, and regular (not miniature) surgical instruments are utilized.
- Mini-Open Surgery: An arthroscope is used for the first stage of the procedure, then a large opening is used so other surgical instruments may be used. The opening does not have to be as large as it would be in an open surgery.
Surgical treatment may involve one of these three methods, and studies have shown that each is equally effective in improving shoulder function. One benefit of arthroscopic surgery, however, is that it usually involves less recovery time. Sometimes an acromioplasty is done at the same time as rotator cuff repair, which involves creating more space in the joint through the removal of bone or tissues. Debridement may also occur, by removing loose tendon, bone or cartilage fragments which have become lodged inside the joint.
Risks and Complications
Your doctor will help you decide if the expected benefits from rotator cuff repair surgery outweigh any associated complications. Some of the risks specific to rotator cuff surgery include:
- Wound infection. You will be given antibiotics to lessen this risk, but if an infection begins you may need additional surgery.
- Re-opening of rotator cuff tear. The larger the tear, the greater the risk that it will re-tear and surgery may be needed, again.
- Stiffness. Most patients experience some initial stiffness, which can be improved with aggressive physical therapy and adherence to exercises to improve strength and range of motion.
- Deltoid detachment. An open repair can cause the shoulder muscle to detach, so this area must be protected after surgery to allow it to heal.
- Nerve injury. The deltoid nerve which activates the shoulder muscle may be damaged if it is cut.
- Unsatisfactory result. If you have a massive tear or do not comply with rehabilitation requirements, you may be displeased with the outcome of your surgery. Smoking may also aggravate the healing process.
Are you tired of pain because of an injured rotator cuff? We have the solution for long-lasting results, with minimally invasive procedures designed for your individual case. For more information about rotator cuff repair in Southern California, as well as other orthopedic services and treatments, please call our West Medical offices at (855) 690-0565.
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