Rotator cuff injuries are one of the most common conditions afflicting the shoulder. It is most common in patients between the ages of 40-70. Injuries to the rotator cuff can be traumatic in nature, typically due to a direct fall onto the injured shoulder. It can also be the sequelae of chronic inflammation within the shoulder. Patients with rotator cuff tears frequently present with pain and weakness in the shoulder.
The etiology of rotator cuff tears can be broadly described as traumatic or atraumatic in nature. Traumatic rotator cuff tears present with sudden weakness within the shoulder following a fall onto the shoulder. Patients between the ages of 40-70 who dislocate their shoulder are at high risk for having sustained a rotator cuff tear.
Chronic inflammation within the shoulder can also lead to rotator cuff tears by causes that are poorly understood. Rotator cuff tears can also be attributed to the normal aging process with age-related degeneration leading to a rotator cuff tear that can become symptomatic.
Patients with rotator cuff tears will commonly complain of night pain that disrupts sleep, difficulty with overhead activities, difficulty lifting objects or reaching away from the body. Patients may also have difficulty reaching behind their back. Weakness is a common complaint that can be progressive in nature depending upon the severity of the rotator cuff tear and the duration of the tear. Pain with certain movements (overhead activities) can lead to a reluctance to perform these maneuvers and subsequent stiffness.
Treatment for rotator cuff tears can be either surgical or nonsurgical. Treatment is individualized based upon the patient. Factors that help determine which treatment is best include the age of the patient, nature of the tear (acute/chronic), severity of the tear, degree of functional limitation and expected activity level.
Nonoperative treatment focuses upon initial pain control, followed by a directed physical therapy program that emphasizes pain-free range of motion of the shoulder and subsequent strengthening of the remaining rotator cuff and periscapular (around the shoulder blade) muscles. Initial pain control often involves the use of
anti-inflammatory medication to help control inflammation within the shoulder.
Operative treatment for rotator cuff tears is reserved for those patients who have significant functional limitations due to pain and weakness as a result of a rotator cuff tear. Further, those patients who are unsuccessful with nonoperative management are candidates for surgery. Repair of the rotator cuff can typically be performed arthroscopically with sutures that can help restore the normal attachment of the rotator cuff muscles. The surgery is performed on an outpatient (same-day surgery) basis with physical therapy commencing approximately a week following surgery, emphasizing gentle range of motion exercises. Patient remain in a sling for the first six weeks following surgery. Recovery generally takes approximately 4 to 6 months.