Department of Orthopaedic Surgery

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Sports Medicine

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.

Causes

The causes 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.

Symptoms

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.

Natural History

Rotator cuff tears are extremely common, with up to 30% of the population over the age of 60 having at least a partial rotator cuff tear.  Partial thickness rotator cuff tears are often asymptomatic and are commonly found on MRI.  Once a tear becomes complete, it is unlikely to heal itself.  Full thickness tears can be asymptomatic or patients can develop symptoms.  As the tear progresses, patients often get an increase in pain and develop weakness.  In very large tears, the muscle can get smaller and the tear can become unrepairable. However, most symptomatic rotator cuff tears can be repaired with arthroscopic techniques with good success rates.

Treatment

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.

Non-operative Treatment

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

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 and typically takes about 90 minutes.

What to expect after surgery

After surgery, patients will be in a sling with a dressing for 5-7 days.  At that time, the dressing and sutures are removed at the first post-operative visit.  The sling will remain on for 6 weeks to protect the repair.  Physical therapy begins the week after surgery and will continue for 3-5 months.

At 6 weeks, the repair is healed and the patient can remove the sling and being active range of motion exercises.  Physical therapy continues with an emphasis on regaining good motion with good control of the shoulder.

At 3 months, the patient should have good range of motion and begin to get the strength back in their arm.  Full recovery typically takes 4-6 months to regain full motion and the strength in the repaired rotator cuff.

For more information on rotator cuff tears from the American Academy of Orthopaedic Surgeons, please visit their Patient Portal.

http://orthosurg.ucsf.edu/wp-content/uploads/media/sports/video/rotator_cuff_no_aud.mp4

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