Rotator Cuff Tears Come in Different Shapes & Sizes
By Dr. Matthew White, Orthopaedic Surgeon, Linn County LIVING WELL Magazine
Rotator cuff tears are one of the more common shoulder injuries seen by primary care physicians and orthopedic surgeons alike. In 2008, more than two million people saw their physician for the evaluation of a rotator cuff problem. An injured or chronically damaged rotator cuff can cause pain as well as weakness. They can adversely affect sleep, mood, and work production. The key is to know the symptoms and see your doctor so that appropriate treatment can begin.
How Your Shoulder Joint Work
The shoulder joint is comprised of several components. There are three main bones:
1) the humerus (arm bone)
2) the scapula (shoulder blade)
3) the clavicle (collarbone)
These bones work together to create a stable platform for the ball and socket of the shoulder joint to work correctly. In addition to the bones, there are other soft tissue structures that function in the shoulder. The labrum works to keep the shoulder in appropriate position. The biceps tendon (which runs through the joint) can augment stability and strength of the shoulder. The rotator cuff compresses the top of the humerus into the socket and drives much of the initial motion in the shoulder.
The rotator cuff is actually made up of four distinct muscles. The muscles begin at the scapula and extend out to the humerus. Directly above the rotator cuff sits the subacromial bursa. This bursa is a fluid-like sac that cushions and lubricates the rotator cuff to allow it to glide freely with motion of the shoulder.
About Rotator Cuff Tears
Rotator cuff tears can be evaluated in a number of different ways. The depth of the tear can be either partial thickness or full thickness and the nature of the injury can be either acute (having just happened) or chronic. Partial thickness tears have some fibers of the tendon still attached to the humerus, while full thickness tears mean that there is essentially a hole between the tendon and bone. Acute tears are commonly the result of a fall on an outstretched arm or caused by trying to pick up something that is too heavy for the arm’s strength. Chronic tears represent more of a “wear and tear” phenomenon in which the tendon has been slowly damaged over time.
How to Spot a Tear
Individuals with a rotator cuff tear generally describe pain as their most common symptom. This pain can be on the outside of the shoulder radiating down the arm or on the front of the shoulder. Often times with acute tears, the pain will be sharp and severe. Chronic tears often have a more dull or throbbing quality to the pain. Pain while not using your shoulder is common, as is pain at night. There may be some feelings of weakness with activity. An overwhelmingly large number of people have difficulty with overhead activities. These symptoms will persist over a time and will often not get better on their own.
When to See a Doctor
Any patient with shoulder pain should get a thorough examination of the joint and its function. This typically involves an evaluation of the range of motion and strength or the shoulder as well as a few tests that can further pinpoint problem spots. Occasionally, people with shoulder problems may actually have symptoms coming from their neck and thus a cervical spine examination is often done as well. Finally, imaging can be very helpful. In general, plain x-rays are obtained first to evaluate for arthritis of the joint, fractures of the bone, or any presence of bone spurs. If a rotator cuff tear is suspected, an MRI can be obtained to get a better look at the soft tissues and their status. Physicians’ Clinic of Iowa Diagnostic Imaging offers x-ray, MRI, and other imaging tests on-site and often at a lower cost than other facilities.
Rotator Cuff Treatment
In the event that there is a rotator cuff tear, there are a number of options for treatment. Chronic tears or acute tears without weakness can often be treated with non-operative measures including:
1) Anti-inflammatory medications (such as ibuprofen)
2) Physical therapy can strengthen the other muscles and maintain motion
3) Activity modification
4) Cortisone injection into the space above the rotator cuff can decrease inflammation and make a difference in pain relief while trying to rehabilitate a tear
Rotator cuff tears do not have the capacity to heal themselves, but it has been shown multiple times that despite this, many people can overcome a small tear with therapy and appropriate medications. In the event that several weeks of non-operative treatment does not work, then the next step is surgical repair.
Surgical Rotator Cuff Repair
Modern arthroscopic techniques allow surgeons to perform rotator cuff repairs through a series of small “poke-hole” incisions that are no bigger than the width of your small finger. The surgical process involves using a very small camera to look into the joint and above the rotator cuff to remove all inflammatory tissue. Bone spurs can also be taken off at that point. The rotator cuff tear is identified and then repaired back to the bone using special anchors that hold the cuff in place while the body heals it back to the bone. Benefits of the arthroscopic technique include better pain control as well as less incisional healing required. Surgery can be done as an outpatient with no overnight hospital stay. Patients are placed into a special arm-sling and begin physical therapy within 24 to 48 hours following surgery. Therapy goals include increased motion and long-term strength of the shoulder. Most people can expect approximately three to four months of recovery following repair, though most people are able to return to office-style work within a week or two. There are some risks to the surgery though they are uncommon. These include infection, nerve injury, shoulder stiffness, and rotator cuff re-tear.
Although rotator cuff tears are common shoulder injuries that can be painful, Physicians’ Clinic of Iowa offers treatment options to reduce pain and increase function. Non-operative treatment can be effective in around 50% of patients and should almost always be considered as a first-line treatment. In the event that non-operative treatments do not improve the shoulder condition, surgery is a reliable option. New techniques including arthroscopic surgery and absorbable anchors allow for less pain with surgery and may facilitate quicker recovery.
Which treatment is right for you? Physicians’ Clinic of Iowa tailors our care to each individual’s specific needs. If you’re experiencing shoulder pain, call 319-398-1545 and make an appointment today. We can discuss the options available and find the right solution for you
