The shoulder is the most flexible joint in the human body, and because of its wide range of motion, it’s more prone to injury than other joints.
A torn rotator cuff is a very common shoulder problem. The rotator cuff is a group of muscles and tendons that stabilize the joint, and a tear can result from an injury such as a fall or heavy lifting. Many times, though, people can’t recall a specific incident in which they hurt their shoulder. The tear occurs slowly, resulting from normal wear and tear and repetitive activities over many years.
As we age, we’re more susceptible to rotator cuff damage. In fact, many older adults probably have a small tear without significant symptoms. According to some estimates, 50 to 60 percent of adults over the age of 60 have a torn rotator cuff. Many people don’t know it because it doesn’t interfere with their day-to-day activities. They may have occasional pain and some minor weakness, but they don’t experience major problems.
People with occasional symptoms are advised to avoid overhead activities, such as lifting weights or heavy items over one’s shoulders, which could make a tear worse. They should also avoid straining to reach something high on a shelf.
Diagnosis: When Pain Becomes More Frequent
When symptoms become more pronounced, people may experience an aching shoulder or “referred” pain that travels down the outside of their arm, usually no farther than their elbow. They may find it difficult to lift their arm.
Individuals are advised to rest their shoulder and take an over-the-counter anti-inflammatory medication to see if pain and function improve. They should also avoid lifting heavy items and reaching for high objects.
It’s human nature to try to ignore symptoms and hope the pain will improve, but if one’s shoulder doesn’t get better after two or three weeks, a visit to a doctor may be in order. A small rotator cuff tear can get bigger and more difficult to treat over time.
People usually decide to see a physician when the discomfort keeps them up at night or they have difficulty with everyday activities, such as putting on a coat, brushing their hair or putting dishes on a shelf. We can generally diagnose a torn rotator cuff from a patient’s symptoms and the physical exam. Sometimes an MRI is ordered, but it’s not always immediately necessary.
The majority of rotator cuff tears can be treated without surgery. Doctors generally prescribe physical therapy and anti-inflammatory medication. Sometimes patients receive a steroid injection to reduce the pain and inflammation, and this makes physical therapy easier.
PRP (platelet rich plasma) treatment is often in the news, and patients ask about it. Most studies show that it won’t heal a rotator cuff tear, although it does appear to reduce inflammation. More research is needed for a definitive answer.
Rotator Cuff Treatment
If a patient tries conservative treatments and continues to have pain and difficulty with activities after two or three months, he or she may consider surgery to repair the tear.
A rotator cuff repair is performed arthroscopically. At HSS, the success rate is over 90 percent in terms of pain relief, restoring function, and improvement in quality of life. The recovery generally takes five to six months, and patients will continue to gain strength and function for up to a year.
Choosing a Surgeon
It’s very important to choose the right doctor. Different physicians use different surgical techniques and have different training. Patients are advised to choose an orthopedic surgeon who performs a high number of rotator cuff procedures, who can communicate effectively and with whom the patient feels comfortable.
It’s not uncommon for me to see patients seeking a second opinion, concerned because the first doctor immediately mentioned surgery. Since many patients will experience significant improvement with a nonsurgical alternative such as physical therapy, I consider it the first line of treatment in most cases. However for some people, the type of tears, circumstances of injury, and patient-specific factors including failure of nonsurgical treatments may make surgery the best option.
Dr. Samuel Taylor, Sports Medicine Surgeon, has developed a unique understanding of the demands and anxieties faced by injured athletes at all levels. His clinical expertise includes minimally invasive and reconstructive techniques of the shoulder, elbow, and knee. Dr. Taylor currently serves as Associate Team Physician for the New York Football Giants and team physician for the Fire Department of New York (FDNY) semi-professional football team.