Both surgical and non-surgical treatments for treating rotator cuff tears help to improve the quality of life in orthopedic patients. Santa Rosa Orthopaedics, which offers the latest non-operative and operative procedures as well as advanced physical therapy, provides cutting edge information about shoulder and rotator cuff pain and options for treatment that can help.

shoulder-painAlthough anyone who is actively participating in sports – particularly those involving overhead motions of the arm – can suffer from painful rotator cuff tears, sudden trauma and the natural aging process are also causes of this sort of shoulder pain. Rotator cuff disorders usually develop over time due to aging, constant overuse, repetitive activity or a combination of these processes. Shoulder pain due to rotator cuff tears is a problem that affects at least two million people in the United States every year and it is an issue that is best treated by a qualified orthopedic surgeon.

How It Works

The rotator cuff is made up of a set of four tendons that connect the main muscles of the shoulder to the upper arm. These tendons and muscles work together to stabilize the shoulder joint and make it possible for the arm to be raised and rotated. Whenever the arm is raised above the head, the upper tendon in the rotator cuff (supraspinatus tendon) and the subacromial bursa which lies on top, glide on the underside of the upper end of the shoulder blade. Pain results when the undersurface of the upper end of the shoulder blade becomes rough or abnormally shaped and rubs or scrapes against the bursa (a fluid-filled sac that cushions and lubricates the area where friction normally occurs) and tendon.

Eventually the tendon’s constant rubbing against the undersurface of the acromion can result in tiny tears and bleeding, leading to weakness in the rotator cuff. When it gets to the point where the tendons in the rotator cuff can no longer balance the upward pull of the muscle in the shoulder (deltoid) the tendon can become even more severely damaged making it more susceptible to partial or complete tears.

Who is At Risk

  • People whose livelihoods necessitates repetitive lifting or activities that create frequent overhead movement (such as carpenters and painters) are also at risk for rotator cuff tears, especially athletes like tennis players and baseball pitchers.
  • Most instances of rotator cuff tears are caused by normal wear and tear that happens slowly over time making people over the age of 40 at greater risk.
  • Young adults are most at risk for rotator tears due to traumatic injury such as a fall, although they can also experience overuse tears due to repetitive sports activity or overhead work.

Know the Symptoms

The most common symptoms of a rotator cuff tear include:

  • Shoulder pain while at rest, particularly at night when lying on the affected shoulder
  • Sudden or increased pain when lifting and lowering the arm or with specific movements
  • A sense of shoulder weakness when lifting or rotating the arm
  • A crackling sensation (known as crepitus) when the shoulder is moved in certain positions

Tears can happen suddenly from a fall and usually cause intense pain and are often accompanied by a snapping sensation and immediate sense of weakness in the upper arm – these types of injuries are best seen by a physician without delay. Tears that develop slowly due to overuse can also cause pain and arm weakness, but the symptoms may be milder and only present when lifting or extending the arm. In this case, over-the-counter pain-killers may relieve the pain at first but eventually the symptoms will become more noticeable and less responsive to pain medication. As the rotator cuff and the shoulder continues to weaken the risk of developing a partial or complete tear also increases. In fact, complete tears are present in 25 percent of patients over the age of 60.

Diagnosing Rotator Cuff Tears

Chronic shoulder and arm pain are always good reasons to see a doctor (and in some cases, shoulder pain may be a sign of a more serious problem, such as a heart attack). But no matter whether the tear is the result of injury or overuse, once the patient decides to visit the doctor, diagnosing the shoulder complaint becomes the first order of business. Identifying the cause of the shoulder pain and the nature of the injury is the job of an experienced orthopedic surgeon, preferably one who is knowledgeable about the complex dynamics and function of the rotator cuff.  X-rays, Magnetic Resonance Imaging and ultrasound may be used to help confirm an injury and determine the amount of inflammation and/or tearing that has taken place.

Non-Surgical Treatments

Early treatment can prevent symptoms from getting worse and will most often mean a quicker return to a normal routine. The patient’s age, level of activity, overall health and the type of tear are all taken into consideration for best treatment options. In about half of all rotator cuff tear patients, nonsurgical treatment works effectively to relieve pain and improve function in the shoulder, however; shoulder strength may not improve without surgery. Some non-surgical treatment options include;

  • Anti-inflammatory medication
  • A break from pain causing activities
  • Physical Therapy
  • Strength training
  • Steroid injections

Surgical Intervention

When a rotator cuff tear does not respond to non-surgical efforts and when quality of life becomes an issue, surgical intervention may be pursued by the orthopedic surgeon. One method considered to be the standard of care is called arthroscopic reconstructive surgery where small incisions and a tiny camera are used to facilitate repair.

Recent advances in this technique make it possible for surgeons to treat larger tears while decreasing the instances of post-operative pain and stiffness. About 80-90 percent of patients find relief of chronic pain and a restoration to more normal function and motion of the arm and shoulder.

Following surgery the patient is required to go through a rehabilitation process involving the use of a sling and physical therapy to avoid stiffness. On-going physical therapy following rotator cuff surgery can last up to 12 weeks and is aimed at helping patients regain strength and function.

Santa Rosa Orthopaedic Medical Group is Here to Help.

If you are suffering from shoulder pain speak with your orthopedic specialist to determine the best route of treatment, or call Santa Rosa Orthopaedic Medical Group at (707) 546-1922 for an appointment. In its efforts to bring the best outcomes to patients, SRO has set the model for exceptional orthopedic care for over 60 years.