Rotator Cuff Tears

Repair cuff tears occur most commonly via two mechanisms. First, a rotator cuff tear can happen acutely such as after a fall on an outstretched hand or with lifting something heavy such as a heavy piece of luggage or yard equipment. The second mechanism by which cuff tears can occur is through degenerative overuse of the tendon with chronic breakdown overtime. This is seen with natural aging as rotator cuff tears are actually quite common among the general population. By the age of 65, about 1 in 5 patients will have a full thickness tear of at least one of the rotator cuff tendons and as patients get older, this incidence rises to as much as 50% by the age of 80. Also, repetitive motions of the shoulder can chronically stress the tendon. Examples of repetitive motions that can irritate the cuff over time include manual labor occupations or hobbies such as weightlifting, golfing, and swimming.

The symptoms of rotator cuff tear include shoulder pain when lifting or reaching far away from the body, especially when lifting overhead or reaching far behind the back and weakness with activity is such as putting dishes up on a cupboard. Also having pain at night, where difficulty comfortable is a very common rotator cuff tear. Rotator cuff pain is often described as being felt over the outside of the shoulder and can radiate down the outside of the shoulder toward the elbow.

A rotator cuff tear is diagnosed on physical exam by strength testing of the cuff muscles. If there is a tear present, patients will have weakness with performing certain motions on the exam. If there remains concern for a possible cuff tear, then appropriate x-rays to look at the shoulder joint would be recommended. MRI remains the gold standard in evaluating the rotator cuff because MRI provides excellent detail with high sensitivity and specificity on if there is a tear present, the type of tear present, how much thickness of the cuff is involved in the tear, how far the tear has pulled back, and the quality of the muscle that is remaining. Additionally, an MRI gives us information on the status of the shoulder cartilage, labrum, and biceps. Finally, the MRI can help us determine if a patient ultimately would benefit most from surgical fixation or if this tear could be treated successfully without surgery. It can be reassuring to patient that not all tears require surgery.

Our preference is to treat these tears non-surgically if possible for most patients. A non-surgical treatment protocol includes a short term period of rest from exacerbating activities such as heavy lifting. Proper physical therapy is essential for recovery with the focus specifically on restoring proper scapular mechanics of the shoulder blade as well as strengthening the deltoid and rotator cuff muscles to help offload the tear. Along the recovery process, a short term course of anti-inflammatory medications can be very helpful in reducing pain and inflammation and facilitating therapy. Lastly, injections can also be considered in certain cases including cortisone based medications or even biologic types of injections such as platelet rich plasma (PRP).

If symptoms persist despite appropriate and thoughtful non-operative treatment or if these tears present in younger patients or after an acute injury, then surgery would usually be recommended. Surgery consists of an arthroscopic rotator cuff repair where while the patient is asleep under anesthesia, small pokehole incisions are used in a minimally invasive fashion to repair the rotator cuff back down to where it needs to be. Recovery time is generally around 4-6 months depending on how extensive the repair was during surgery. Overall, the success rate for arthroscopic rotator cuff repair is very high with highly motivated patients undergoing our structured rehabilitation protocol.

If a patient actually has a rotator cuff tear, we recommend that it be treated appropriately and in a timely manner. Ignoring a rotator cuff tear does risk the tear growing over size like Velcro peeling off slowly over time as the patient performs more challenging activities with the shoulder. Additionally, an untreated tear can lead to atrophy of the muscle, which can eventually become irreversible. This can lead to a special form of shoulder arthritis called rotator cuff arthropathy where because the rotator cuff does not stabilize the shoulder appropriately, the patient suffers from secondary arthritis.