Rotator Cuff, Shoulder Pain and Injuries

Andrew Green, MD
Rotator Cuff Injury

Many people experience shoulder pain. Rotator cuff conditions are the most common cause of shoulder pain and include tendinitis, bursitis, strains, and tears. Rotator cuff tears are the most severe of these conditions.  

What is the rotator cuff?

The rotator cuff is an important group of four muscles and tendons in the shoulder that provide stability, strength and function. The muscles are attached to the scapula (shoulder blade) and cross the glenohumeral joint (ball and socket) to become the tendons that blend together to form the cuff.  The tendons attach to the upper part of the humerus (arm bone).  

How common is a torn rotator cuff?

Approximately three million people in the United States have a rotator cuff tear.  Some have no symptoms and are not aware that they have a tear.  While most rotator cuff tears result from degenerative changes that occur with aging, some are the result of overuse or traumatic injury.  In fact, it is rare for a patient below age 40 to have a rotator cuff tear unless they do a lot of repetitive activities or have a significant injury.  On the other hand, rotator cuff tears become more and more common with increasing age. While only 10 to 15 percent of those aged 50 to 59 might have a tear, that percentage increases with each decade, with about 50 percent of those age 80 and above having a tear.

Rotator cuff tears

Rotator cuff tears can be partial or full thickness and come in a range of sizes. In almost all cases the tear involves detachment of the tendon from the bone. It is important to point out that rotator cuff tears can lead to progressive deterioration and atrophy of the muscles, which can affect shoulder strength and function.  

Evaluating shoulder pain

First, it is important to make a correct diagnosis as there are other conditions that cause shoulder pain, which would require different treatment.  The typical patient presents with shoulder pain that can radiate to the arm.  Pain is often worsened with lifting, reaching and overhead use, and many patients have night pain.  The size of the tear does not determine the amount of pain, but patients with larger tears are more likely to be weak.  

The initial evaluation involves a physical examination and plain X-rays.  In most cases, patients with shoulder pain can be treated with temporary activity modification, over-the-counter medications, corticosteroid injections, and appropriate exercises.  Many patients respond to this non-surgical approach and do not require special testing such as Magnetic Resonance Imaging (MRI).  MRI is typically ordered when a patient does not improve.  

When there is a significant shoulder injury magnetic resonance imaging (MRI) should be considered earlier to evaluate the rotator cuff, especially if the patient cannot raise their arm and pain does not resolve over a short time period.

Unfortunately, rotator cuff tears do not heal on their own and tears can progress with time. Despite this, many patients with symptomatic rotator cuff tears can be successfully treated without surgery, using physical therapy exercises.   

When is surgery appropriate for a rotator cuff?

In most cases that do not involve a traumatic injury, rotator cuff surgery is indicated when non-surgical treatment is unsuccessful and a patient’s pain and function significantly affect their quality of life.

There are between 400,000 to 500,000 rotator cuff repairs performed each year in the United States. That number is expected to increase over the coming years.  

Early surgery is considered when there is a significant recent injury, especially if the tear is large. Before proceeding with surgery, the patient and surgeon must consider the goals and expectations, as well as the patient’s overall physical and medical status.

If surgery becomes necessary, most rotator cuff tears can be repaired with outpatient arthroscopic surgery using anchors and sutures to reattach the tendon to the bone. Arthroscopic surgery is a less invasive technique than traditional open repairs.  

There are some tears that are too extensive to be repaired.  In these cases, partial repairs or reconstructions with muscle/tendon transfers or tissue grafts may be used by the surgeon.  In even more severe cases, a shoulder replacement may be required to relieve pain and restore function.

What to expect after rotator cuff surgery

While the surgery is fairly routine, the post-operative recovery can be demanding. It requires a team approach that involves the patient, surgeon, and a rehabilitation specialist.  Patients need to be committed to doing extensive exercises to recover their shoulder motion, strength and function.  

Patients return to many of their light, regular daily activities after about six weeks and are usually doing very well after three months.  Full recovery is achieved sometime between six months to a year after surgery.

Preventing shoulder injuries

There are things you can do to help prevent shoulder pain and rotator cuff tears.

  • Get regular exercise, including stretching exercises, and be sure to warm up and cool down.
  • Focus on nutritious foods in your diet.
  • If you smoke, quit.
  • Maintain good posture and be extra careful when doing activities that involve reaching overhead.
  • Pay attention to your body. If you feel pain, don’t ignore it.

If you are experiencing shoulder pain, we can help. Visit our website for more information.

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