Rotator Cuff Tear

Do you experience pain or weakness around your shoulder when rotating your arms or lifting them above your head? Does your shoulder hurt when lying in bed at night? You might be suffering from a full or partial rotator cuff tear.

Rotator Cuff Tear: What is it?

The rotator cuff is a confluence of four muscles that connect the upper arm bone (humerus) to the shoulder blade (scapula) and assists in elevating rotating the arm. These muscles are connected to the arm and shoulder bones by tendons that can fray or tear, causing a painful rotator cuff injury. Rotator cuff injuries can be identified as inflammation injuries, partial tears, or full tears.

Man suffering from rotator cuff tear injury

Symptoms: What does a Rotator Cuff Tear feel like?

Rotator cuff pain is often felt on the top and/or outside part of the arm and shoulder and can extend down the arm near the biceps. It rarely causes pain that passes the elbow or extends up into the neck. Rarely, rotator cuff pain can cause scapular (shoulder blade) pain, but more often scapular pain is caused by other sources such as neck or cervical spine injuries. Often, rotator cuff pain often occurs while lying flat, such as when you are sleeping. Rotator cuff pain can cause decreased range-of-motion and weakness of the shoulder. When patients have rotator cuff pain, it may be difficult to perform activities away from the body or overhead.

Many rotator cuff tears are asymptomatic, meaning that patients may not have pain or weakness or limited range-of-motion. It is not uncommon for patients to have a rotator cuff tear well before they develop pain or weakness or loss of range-of-motion.

Causes

Rotator cuff tears can be caused by a number of common daily activities as well as happening over time as you age. Some common causes or rotator cuff injuries are:

Falling down awkwardly and catching yourself with an extended arm
Lifting something very heavy
Repetitive lifting, especially over your head
General wear and tear on the shoulder area after years of use

Data suggests that there is a 10–25% chance of having a rotator cuff tear in patients 60 years of age or older. Most rotator cuff tears are chronic and degenerative, meaning that they occur spontaneously without a fall or trauma causing the tear itself.

If a rotator cuff tear develops, it is also common to have a tear in one of the biceps tendons that enters the shoulder (long head of biceps). In a study performed at Orthopedic Institute, 60% of patients with a full-thickness tear in one of their rotator cuff tendons had a concomitant tear in their long head of the biceps tendon.

Evaluation: How is a Rotator Cuff Tear diagnosed?

Rotator cuff tears can be diagnosed by your physician via a history and physical examination. Other ways to confirm the diagnosis include magnetic resonance imaging (MRI) or ultrasonography. Occasionally, radiographs may show secondary signs of chronic rotator cuff tears.

Treatment

Non-operative treatment

The vast majority of patients that have rotator cuff inflammation or partial thickness tears can be treated successfully without surgery—even those patients that have been diagnosed with a “spur” (acromial enthesophyte).

Non-operative treatments include:

Rest
Over-the-counter medications
Physical therapy
Judicious use of corticosteroid (cortisone) injections
A gradual progression back to normal activities

The optimal treatment for full-thickness tears is unclear and should be discussed with your physician. Many patients can be treated successfully with non-operative treatment (including physical therapy) even with a full thickness tear.

The Multicenter Orthopedic Outcomes Network (MOON), of which Orthopedic Institute is a member, has demonstrated that up to 75% of patients willing to treat their full-thickness rotator cuff tears non-operatively with physical therapy have been successful in avoiding surgery for at least 5 years after their diagnosis. We will be continuing to follow these patients to determine if this success remains durable up to 10 and even 20 years after surgery.

The potential concern with treating full thickness tears of the rotator cuff is that the natural history of rotator cuff tears suggests that rotator cuff tears can enlarge and retract over time. Some tears can become so large so that they may be impossible to fix primarily with surgery. Unfortunately, there are not many factors known that assists us in guiding which tears will progress further in severity and those that will stay the same size. If a patient wishes to treat their full-thickness rotator cuff tear without surgery, we recommend they have regular MRI scans to ensure the tears are not getting worse. However, if initial non-surgical attempts at treating full-thickness tears were successful but the pain does return, it is often advisable to consider rotator cuff surgery because pain recurrence is a potential sign that the rotator cuff tear severity is worsening.

Surgical treatment for rotator cuff inflammation or partial-thickness tears is rare and should only be considered if non-operative approaches have not demonstrated success.

Surgery

Surgical treatment of full-thickness rotator cuff tears performed at the Orthopedic Institute has been proven to be a successful way of curing shoulder pain with high rates of sustained patient satisfaction.

Surgical treatment is the only way to anatomically fix a full-thickness rotator cuff tear. Rotator cuff repairs are now performed arthroscopically through tiny button-hole incisions and rarely require large, open incisions. If a biceps tendon tear is found at the time of surgery, it can often be repaired at the same time as the rotator cuff repair itself. It is an outpatient surgery, meaning that patients may return home on the same day as their surgery.

Prior to surgery, specialists at the Orthopedic Institute will assess each patient for their potential to respond successfully to arthroscopic rotator cuff repair. Some patients have chronic tears with severe and significant retraction of their rotator cuff tears, which make it impossible for surgery to successfully heal the tendon tear. In these cases, patients are often treated non-operatively with corticosteroid injections and/or physical therapy. If non-surgical attempts are unsuccessful, treatment options may include performing a superior capsular reconstruction or a reverse total shoulder arthroplasty.

When performing superior capsular reconstruction, Orthopedic Institute surgeons use cadaver tissue to reconstruct the superior capsule and repair the remaining rotator cuff to the capsular reconstruction.

When performing reverse total shoulder arthroplasty, Orthopedic Institute surgeons place a prosthetic total shoulder replacement (an artificial joint) that is specifically constructed to improve quality-of-life by decreasing shoulder pain and improving range-of-motion and strength in patients with irreparable rotator cuff tears.

An Orthopedic Institute shoulder specialist will be able to help guide you to which option might be best for you.

Recovery: What Can Be Expected?

For non-operative treatment, your physician will instruct you on any limitations you may have on your activities to ensure the best possible recovery.

For surgical treatment, a sling is typically required for the first 4–6 weeks after surgery. Often, physical therapy is required after surgery to help regain range of motion and strength.

Light activities may be performed for the first 3 months. Typically, it takes more than 3–5 months to consider medium to heavier activities. Activities that require significant strength and endurance or are performed repetitively over the head may not be possible for up to a year after surgery. Surgeons often recommend that patients continue to perform their home rehabilitative exercises up to a year after surgery.

Physicians

The following physicians specialize in the treatment of Rotator Cuff Tears:

R. Blake Curd, MD

Matthew J. McKenzie, MD

Joshua J. Meaike, MD

Dustin P. Collins, MD

Erik D. Peterson, MD

Peter A. Looby, MD

Evan N. Hermanson, MD

Keith M. Baumgarten, MD

Jason L. Hurd, MD

Joshua J. Meaike, MD

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Testimonials

I have had a knee and two shoulder replacements plus a diagnosis on an injury to my leg that probably saved muscle loss. I feel that Dr. Zoellner is the best orthopedic doctor that I could possibly have.

Love OI and Dr. Curd. He’s helped me with a couple of issues and I couldn’t be more pleased. The PA Chad is wonderful as well. The surgery went well, treatment(s) for another issue are as easy as they can be and easily scheduled. Definitely recommend Dr. Curd to anyone with hand or shoulder issues!

What a great doctor. Dr. Looby has seen me through knee and shoulder surgeries, with great skill and care. He always makes sure I am doing ok and answers all my questions and listens to my concerns. It has been an awesome journey to being pain-free and able to function normally. I will be able to dance at my daughter’s wedding. I am so grateful. What a blessing!

Dr. Baumgartner’s kind and pleasant personality set me at ease for the complex shoulder replacement surgery. He’s an outstanding and highly skilled surgeon; I highly recommend him.

From my first consult, I liked Dr. Hermanson and felt very confident in his abilities to fix my shoulder. My surgery and hospital stay were so positive! I recommended him to a friend and he did her surgery as well. He and his staff are professional, kind and a pleasure to work with! I highly recommend him!

Liz Hansen

Rotator Cuff Tear