Rotator cuff tears effect many people and are increasingly common with age. >50% of people over 60 years old have a rotator cuff tear. Some rotator cuff tears are asymptomatic. Others can cause significant pain and disability.
Symptoms of a Rotator Cuff Tear
- Pain worsened with overhead activity or reaching
- Pain at night while sleeping
- Weakness in the involved shoulder
The rotator cuff is a group of four muscles that attach to the humerus. They aid in elevation and rotation of the shoulder. The muscles involved are the supraspinatus, infraspinatus, subscapularis and teres minor.
When one or more of the rotator cuff tendons is torn, the tendon no longer fully attaches to the head of the humerus. Most tears occur in the supraspinatus muscle and tendon, but other parts of the rotator cuff may also be involved.
In many cases, torn tendons begin by fraying. As the damage progresses, the tendon can completely tear, sometimes with lifting a heavy object.
There are different types of tears.
- Partial Tear - Partial detachment of the rotator cuff from the bone. Often responds well to physical therapy
- Full-Thickness Tear - This type of tear is also called a complete tear. In this case the tendon has a complete defect in its attachment to the bone. Depending on patient age and activity level, this group of tears may require surgery.
To diagnose a rotator cuff tear, your doctor will give you a thorough physical exam. He or she will want you to move your arm in different directions to see what causes pain. In addition, your doctor might want to order the following tests:
- X-ray of the shoulder with some special views
- MRI (Magnetic Resonance Imaging)
In about 75% of patients, nonsurgical treatment relieves pain and improves function in the shoulder. Shoulder strength, however, does not usually improve without surgery.
Nonsurgical treatment options may include:
- Activity modification. Avoid activities that cause shoulder pain.
- Non-steroidal anti-inflammatory medication. Drugs like ibuprofen and naproxen reduce pain and swelling.
- Physical therapy. Specific exercises will restore movement and strengthen your shoulder. Your exercise program will include stretches to improve flexibility and range of motion. Strengthening the muscles that support your shoulder can relieve pain and prevent further injury.
- Steroid injection. If rest, medications, and physical therapy do not relieve your pain, an injection of a local anesthetic and a cortisone preparation may be helpful. Cortisone is a very effective anti-inflammatory medicine.
Patients who fail physical therapy, younger more active patients, and those with traumatic tears require surgery. The surgery is done with a special camera and tools in a minimally invasive fashion. Typically patients have the entire repair completed through three small portals.
Rehab and Recovery
Most patients are in a sling for 6 wks after surgery. We start therapy two weeks postoperatively. The therapy follows a strict protocol based on returning strength and function to the shoulder.