Vic Goradia, M.D., Go Orthopedics

Rotator Cuff Tears 

We "shoulder" responsibility, put our "shoulders to the grindstone" and occasionally "carry the weight of the world on our shoulders."

Perhaps that’s why more than 4 million people in the U.S. seek medical care each year for shoulder problems. Although there are many reasons for shoulder pain, a common problem for people over 40 years of age is a rotator cuff tear.

The rotator cuff is comprised of the muscles and tendons that surround the top of the upper arm bone (humerus) and hold it in the shoulder joint. A tear may result suddenly from a single traumatic event or develop gradually because of repetitive overhead activities.

During your medical consultation, your physician will ask you about your symptoms and any recent trauma or injuries. Your doctor will carefully examine the top and back of your shoulder to see if the muscles have begun to shrink, called atrophy. You may be asked to move your arm in several directions, or to hold it in various positions. X-rays can help the doctor see any problems with the bones, although other imaging tests may be required to confirm a rotator cuff tear.

Signs and Symptoms

• Recurrent, constant pain, particularly with overhead activities.
• Pain at night that prevents you from sleeping on the affected side.
• Muscle weakness, especially when attempting to lift the arm.
• Catching and grating or cracking sounds when the arm is moved.
• Limited motion.
• Usually occurs in the dominant arm (right shoulder for right-handed people; left shoulder for left-handed people).
• May be triggered by a specific incident.

Risk Factors

• Repetitive overhead motion, such as pitching or painting a ceiling.
• Heavy lifting.
• Excessive force, such as a fall.
• Degeneration due to aging, including a reduction in the blood supply to the tendon.
• Narrowing of the space (acromioclavicular arch) between the collarbone (clavicle) and the top portion (acromion) of the shoulder bone (scapula).
• Rubbing (abrasion) of the cuff surface by the top portion of the shoulder bone.

Diagnosing a Tear

One such test is an arthrogram, in which a dye is injected into the joint before the X-ray is taken. Other imaging tests can include a MRI and ultrasound. Rotator cuff tears may be partial- or full-thickness. Partial-thickness tears do not completely sever the tendon and may respond well to non operative treatments. Full-thickness tears require surgery to correct. Surgery may also be used to treat partial-thickness tears that do not respond to non operative treatment. Treatment Your doctor will prescribe a treatment plan based on your injury and your need for pain relief, movement and function. In most cases, the initial treatment is a non surgical one that involves several modalities. These include:

• Rest. If the tear is due in part to overuse, resting the shoulder may help.
• Non-steroidal anti-inflammatory medications to help control pain.
• Strengthening and stretching exercises as part of a physical therapy program.
• Corticosteroid injections can help reduce pain but cannot be repeated frequently because they can weaken the tendon.
• Ultrasound can enhance the delivery of topically-applied drugs and has thermal effects that may also help in the healing process.

Surgical Options

There are several surgical options to treat rotator cuff tears, depending on the size, depth, and location of the tear. If other shoulder problems are discovered during the surgery, they will be corrected as well.

• Arthroscopy, in which instruments are inserted into small incisions, can be used to remove bone spurs or inflammatory portions of muscle and to repair lesser tears.
• A mini-open repair that combines arthroscopy and a small incision can be used to treat full-thickness tears.
• In more severe cases, open surgery is required to repair the injured tendon. Sometimes a tissue transfer or a tendon graft is used. Joint replacement is also an option.

Rehabilitation

It takes some time to recover from shoulder surgery and full function may not return for six months or more. Your orthopaedic surgeon will recommend a program of exercises to strengthen and restore motion. Your commitment to follow the outlined program will make a difference in the ultimate results. Although every case is unique, surgery can relieve pain for most people and rehabilitation can restore functional range of motion.