The rotator cuff is a group of muscles and tendons that surround the shoulder joint, keeping the ball (head) of the humerus (upper arm bone) firmly within the shallow socket of the shoulder blade (glenoid). Further than keeping the ball in the socket, the cuff muscles help lift and rotate the arm.
Rotator cuff tears occur when tendons pull away from the arm bone. A tear may result from overuse/chronic wear & tear, or from an acute injury. Tears are common and increase with age.
Tears of the rotator cuff may be incomplete (partial tears) or incomplete (full-thickness tears).
Anyone can experience a rotator cuff tear, but people over 40 are more at risk. Tears can be caused by an injury to the shoulder, i.e., associated with a dislocated shoulder. However, most tears are so-called degenerative, due to chronic wear & tear. Bone spurs rubbing on the tendon (impingement syndrome) may eventually lead to a full-thickness tear. Also, repetitive use of the shoulder on the job or during sports may contribute.
What are risk factors for rotator cuff tears?
Risk factors for the development of rotator cuff tears include:
• Age > 40
• Smoking
• Poor posture at work or poor technique during sports
• Professions such as painters, carpenters, mechanics
• Sports like tennis, softball or rowing
Symptoms of rotator cuff tears may include:
• Pain and weakness while raising your arm overhead
• Inability to raise overhead
• Pain when lying on your arm
• Pain that worsens at night and disturbs your sleep
• Struggling to lift objects
• Difficulty performing activities of daily living
Dr Panagopoulos will take a full history and perform a detailed physical exam, including measuring range of motion and strength. An x-ray will be ordered to look for arthritis or bone spurs. An ultrasound in the office will be performed to look for tears. An MRI may be ordered to further clarify your anatomy and the extent of the damage.
How is a rotator cuff tear treated?
Conservative treatment of rotator cuff tears includes:
• Rest
• Activity modification
• Stop sports for a while to give your shoulder time to heal
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Physiotherapy for strengthening and stretching exercises
• Steroid injection
Rotator cuff tears do not heal on their own without surgery. However, many patients can improve functionally and have less pain by strengthening their shoulder muscles (deltoid strengthening, in particular). Surgery is generally recommended if you have a full tear or your tear failed to respond to a 3-month trial of conservative management, including physiotherapy and injections. Most cuff surgeries can be performed arthroscopically. Dr Panagopoulos performs shoulder arthroscopy through 3 small incisions (4mm), through which he inserts a small camera and a variety of instruments. The bone spurs are trimmed, and the torn tendon is repaired to its anatomical position (footprint). Any other pathology encountered (biceps lesions, ACJ arthritis, etc.), is also addressed. This is a day procedure. It is performed under general +/- regional anesthetic. You can go home the same day if you wish, just a few hours after the procedure. Your arm will stay in a sling for 4 to 6 weeks after the procedure based on the size of the tear. Then you will start physiotherapy. Most patients regain shoulder motion within 3 months and strength within 6 months, but full recovery may take up to a year.
Some tears are not repairable due to their size (massive tears), or due to poor quality of the tissue. These are the so-called irreparable tears. Those tears may necessitate another procedure, such as debridement of scar tissue without repair, a tendon transfer, or a reverse shoulder replacement.
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