I TORE MY ROTATOR CUFF, NOW WHAT?

The rotator cuff is the group of four tendons and muscles that surround the shoulder joint. When the rotator cuff is injured, it is the tendons of these muscles that are injured. Tendons connect muscle to bone, and can be susceptible to inflammation or tearing near this attachment.

Different Rotator Cuff Tears

With a complete tear of the rotator cuff, one (or several) of the four tendons detaches from the bone, leaving an abnormal gap between the two structures. When this occurs, the normal muscle contraction is decreased in strength. It may also cause pain when performing the intended motion. Most tears occur in the supraspinatus (“top” of the cuff) tendon, but the subscapularis (front) and infraspinatus (back) tendons may also be involved.

With a lesser injury, or often with chronic wear and tear, the rotator cuff tendons may be compromised with a partial tear. In this case, the tendon is decreased in width, or thickness, and inflamed. This may also lead to pain and weakness with motion of the shoulder, especially with overhead use of the arm.

Rotator Cuff Tear Causes

Tearing the muscles and tendons in the rotator cuff group can be caused by damage from an acute injury, repetitive overuse, or result from the gradual degeneration of the muscle and tendon from aging. In younger patients who suffer rotator cuff injuries, high impact injuries related to falls, contact sports or motor vehicle accidents are usually responsible for full thickness (complete tears). However, as we age, many more people develop tears of the rotator cuff, despite having no history of any injury at all.

Patients of all ages may develop partial tears or painful inflammation of the rotator cuff, especially those who play repetitive sports or frequently overuse the rotator cuff. Individuals who begin a new sport or activity at a high level without properly preparing are at an increased risk of injuring the rotator cuff.

Rotator Cuff Tear Risk Factors

Because most rotator cuff tears are largely caused by the normal wear and tear that goes along with aging, people over 40 are at greater risk. It has, in fact, been shown that with each decade, a higher percentage of asymptomatic people – who never had shoulder pain – do have a complete tear of the rotator cuff when examined with MRI. People who do repetitive lifting or overhead activities, such as painters or carpenters, are also at risk for rotator cuff tears. Athletes are especially vulnerable to overuse tears as well, especially overhead athletes such as tennis players and baseball pitchers.

Diagnosing a Rotator Cuff Tear

If you think you may have a rotator cuff injury, it is helpful to see an orthopedic shoulder specialist, such as Dr. Millstein. He will examine your shoulder, checking your range of motion, strength and putting your arm in particular positions to see if you have pain consistent with a partial or complete rotator cuff tear. He will also examine your neck to make sure that the pain is not coming from a “pinched nerve,” and to rule out other conditions, such as arthritis. Dr. Millstein also uses imaging tests, such as X-rays and MRIs, to confirm your diagnosis when necessary.

Non-Surgical Rotator Cuff Tear Treatments

If you have a rotator cuff tear and you keep using your arm and shoulder despite increasing pain, you may damage it further. With that said, know that non-surgical treatment relieves pain and improves function in many patients with partial tears, and even some with complete tears. Non-surgical treatment options include, but are not limited to:

• Rest (and limited overhead activities)
• Activity modification (avoid activities that cause pain)
• Anti-inflammatory medication (drugs like ibuprofen can reduce pain and swelling)
• Physical Therapy (exercises will restore movement and strengthen the shoulder)
• Steroid injection (if all else fails, a steroid injection may prove to be very effective)

Surgical Rotator Cuff Tear Treatments

While nonsurgical treatments can help relieve pain and improve function, surgery is often needed if you want to regain shoulder strength. If your pain does not improve with non-surgical methods, you may benefit from surgery. The same is true if you are very active and use your arms for overhead work or sports.

Other signs that surgery may be a good option for you include:

• Your symptoms have lasted 6 to 12 months
• You have a complete tear that compromises your function
• You have significant weakness and loss of function in your shoulder
• Your tear was caused by a recent, acute injury

Repairing the rotator cuff usually involves removing loose fragments or tendon, bursa, and other debris from the space in the shoulder where the rotator cuff moves. If the rotator cuff is pinched or irritated, it needs more room to move smoothly. This problem is usually solved by shaving bone or removing bone spurs from the point of the shoulder blade.

A common treatment option is arthroscopic rotator cuff repair surgery, a minimally invasive procedure performed using a video camera and specialized instruments through small incisions around the shoulder area. A mini-open repair relies on arthroscopy and a small incision to treat complete tears, while open surgery is sometimes best to repair severely injured tendons.

If you have suffered a rotator cuff tear, schedule a consultation with Beverly Hills orthopedic surgeon Dr. Millstein today by calling (310) 595-1030.