What is the Rotator Cuff?
The rotator cuff is an intricate group of four small tendons that regulate movement of the shoulder. The purpose of these four tendons are to maintain the position of the humeral head (ball) on the glenoid (socket) of the shoulder during movement. These deep tendons around the shoulder are referred to as postural muscles–a postural muscle is one which is active with many fine and mundane movements in normal life. In contrast, the deltoid muscle provides power and strength to the shoulder and is primarily active with more strenuous and explosive movements. While the rotator cuff does not directly contribute to power movements of the shoulder, significant damage to the rotator cuff leads to an “uncoupling” of the powerful deltoid from the shoulder joint.
How do Rotator Cuff Tears occur?
There are two types of rotator cuff tears: Degenerative and traumatic. Since the rotator cuff is involved in so many aspects of shoulder and arm use,it is vulnerable to wear and tear as we get older, even from routine everyday use. Conversely, traumatic tears occur suddenly, with injury. Violent pulling of the arm, falling onto the shoulder and other types of trauma can cause the rotator cuff to acutely tear. These result in pain, sudden loss of the ability to raise the arm away from the body. These typically have a narrow window of several weeks during which these can be repaired for best results. Beyond this window, the tendon quality and ability of the tendon to heal can become impaired.
I never injured my shoulder–how did I tear my Rotator Cuff?
Traumatic tears occur with injuries, however degenerative tears are actually more common. Degenerative tears of the rotator cuff occur over one’s lifetime. Health and genetics certainly can affect development of tears. Two people over time with similar activities may develop tears in their tendon at vastly different periods in their life. These differences are largely due to health and genetics. Certainly, prolonged strenuous use of the shoulder can make these tears more likely. Additionally, bone spurs in the shoulder can mechanically damage the tendon over time. However, this phenomenon, known as external impingement, is less common than previously thought. Degenerative tears occur over time and may not always be initially symptomatic.
How do I know if I damaged my Rotator Cuff?
Common symptoms of rotator cuff problems include pain with reaching, painful clicking in the shoulder, difficulty performing strenuous or athletic activities, especially throwing. Loss of strength holding the arm away from the body can occur as can pain radiating down the arm, not necessarily at the shoulder itself. Arm pain at night is also strongly associated with rotator cuff disease. However, the symptoms of shoulder bursitis, rotator cuff tendonitis and rotator cuff tears overlap significantly, therefore it is recommended that you be evaluated if you have these types of symptoms.
Is surgery the only option for my Rotator Cuff Tear?
This depends heavily on the characteristics of your tear but surgery is never the only option. There are certain tears for which we recommend against surgery and certain tears for which the outcome may be best with surgery. Partial tears in particular are very amenable to nonsurgical treatment, including rest, physical therapy and injections or a combination of these measures.
Physical therapy is highly effective for rotator cuff disease when performed in conjunction with our specific recommendations to target the specific tendons of the shoulder that are affected. Oral anti-inflammatory medications may be recommended. Additionally, cortisone injections can be quite helpful as a part of treatment but are used on a repeated basis only in specific settings. Regenerative medicine, particularly PRP injections can be effective in select types of rotator cuff issues.
What type of surgery is recommended for Rotator Cuff Tears?
If surgery is recommended, this is typically done as an outpatient and done arthroscopically. This is a brief, routine procedure but the recovery can take some time since the rotator cuff is a slow healing tendon. Recovery from rotator cuff surgery can take several months and involves regular attendance at physical therapy. Depending on the physical demands of your job, some time off work may be necessary. However, success rates of arthroscopic rotator cuff repair are very high and the vast majority of people return to previous activities including golf, tennis and other more vigorous activities with appropriate postoperative guidance. We will continue to follow and guide you until you’ve reached that point. Often, other minor issues which typically may not otherwise require surgery, such as arthritis, bone spurs and bursitis are addressed at the same time as the rotator cuff.