Rotator Cuff Tear
Rotator Cuff Tears and Surgery
If you’ve ever played baseball or softball more than just at the office summer picnic, you’ve either had problems with your rotator cuff or you probably know someone who has. The rotator cuff is prone to wear and tear and acute injury.
Dr. Adickes in Houston, TX has both personal experience and extensive training with rotator cuff injuries. Helping patients with this heavily used part of the shoulder was part of Dr. Adickes’s motivation in receiving his medical degree and orthopedic surgery training, and then opening his practice in Houston. He can help with your rotator cuff injuries.
What is the rotator cuff?
The rotator cuff consists of four muscles and tendons whose function is to pull and maintain the ball of the humerus into the center of the shoulder joint. Of the four muscles that make up the rotator cuff, the muscle that attaches to the top of the humerus, the supraspinatus, is the most prone to injury as it receives the most stress of the entire cuff. When one of the rotator cuff tendons tears, the tendon no longer is completely attached to the head of the humerus.
What causes a rotator cuff to tear?
The rotator cuff usually tears either from acute injury or from accumulating wear and tear and degeneration of the tendon tissue. Certain movements, such as pitching a baseball, and repeated overhead activity or lifting can damage the tendon.
There are a few risk factors, making it more likely you’ll tear your rotator cuff:
- Sports — Sports with repetitive arm motions, such as throwing a baseball or softball, serving tennis ball, or shooting an arrow, increase risk.
- Age — Rotator cuff tears are most common in people over 40.
- Construction jobs — Jobs where you must work overhead, such as painting or carpentry, can damage the rotator cuff over time.
- Genetics — There is a genetic predisposition, as the injury can run in families.
How do I know I have a rotator cuff tear and may need surgery?
An acute tear, such as if you put your arm out to break a fall, is often accompanied by a snapping sensation. Plus, the pain is intense.
In degenerative conditions, you’ll notice weakness, persistent pain, tenderness, and the inability to move your shoulder into a variety of positions. These are all signs of a possible rotator cuff tear. You’ll feel the most pain when reaching directly above your head, behind your back, and when lifting motions involve your shoulder. You’ll also have pain when lying on your side with the bad shoulder.
There are different degrees of rotator cuff damage or tears:
- Grade 1 — This stretches the fibers without a physical tear. A strain.
- Grade 2 — This is a partial tear, but the tendon is not completely severed.
- Grade 3 — This is a full-thickness tear that creates a hole through the tendon, splitting the soft tissue into two pieces.
How will I know if I need rotator cuff surgery?
This is a matter of the person. If the conservative treatments above don’t seem to be having an effect and you’re dealing with pain when sleeping and doing routine, mundane tasks, it could be time to consider surgery with Dr. Adickes. Also, if you want to stay active in the areas that caused your injury, such as construction work, surgery will be necessary to be able to build strength back in your shoulder, once the tear is repaired.
These would be situations where Dr. Adickes would likely recommend surgery:
- You have a large tear
- Your tear was caused by an acute injury
- You have a significant amount of weakness
- You have lost function in areas where you cannot tolerate it
- You have had significant pain for over six months
Does rotator cuff tears always need surgery?
There is a misconception about the rotator cuff. Once there is a tear in one of the tendons it will not heal itself. A grade 1 strain can heal itself, but a tear will not. That said, surgery is not always necessary. Treatments are available that can relieve the pain and improve function. The problem with these treatments, however, is that the shoulder will not strengthen again. It is also possible to turn a minor tear into a major tear by continuing to use the shoulder.
If a patient wants to avoid surgery, at least for a period of time, these are the possible treatments for a torn rotator cuff:
- Rest. This includes limiting any overhead activities and not raising your arm above your shoulder. If your tennis playing has led to the problem, you’ll have to give it up. Same with swimming or playing baseball or softball
- Non-steroidal anti-inflammatory medicine. Ibuprofen and naproxen reduce pain and swelling.
- Strengthening exercises and physical therapy. Strengthening the muscles that support the shoulder can restore movement and help with flexibility.
- Steroid injections. Cortisone injections are effective anti-inflammatory medicine and will eliminate pain, but there is some thought they may also weaken the tendons. This is not a long-term solution.
What is recovery like after rotator cuff surgery?
Dr. Adickes performs this surgery with both open and arthroscopic methods, obviously using arthroscopic methods whenever possible. Your recovery will be dictated to a degree by which method was used for your surgery. With the open method, you’ll likely spend at least one night in the hospital.
Once home, your rehabilitation is not easy or fast; there are no shortcuts here if you want a successful end result. Your rehabilitation will involve three steps:
- 3) Immobilization — This first phase aims to protect your surgically repaired tendon. You will wear a sling to keep your arm from moving, and will not be able to use it. The length of this phase depends on the severity of your tear, but will last from 4 to 6 weeks.
- 2) Passive exercise — A physical therapist will help with this second phase, the goal being to strengthen the surrounding muscles and improve range of motion. This will begin sometime within the first 4 to 6 weeks after surgery. The therapist will generally support your arm, moving it in the desired directions.
- 1) Active exercise — After 4 to 6 weeks, you will begin active exercises under the guidance of a therapist. Then at 8 to 12 weeks, you will shift to strengthening exercises.
Full recovery can take up to one year, with adequate strength and function coming somewhere between 4 to 6 months after surgery. Commitment to rehabilitation is key to a successful final outcome.