Rotator cuff injuries are extremely common and affect up to four million people yearly. These types of injuries increase with age and commonly occur in those who play repetitive motion sports or have a job involving motions that remain the same all day. Some rotator cuff injuries can recover with simple rest and pain management, while other more severe forms of injury might require surgical repair.
What is a rotator cuff?
Your rotator cuff is a group of muscles and tendons that hold your shoulder together. The rotator cuff keeps the top of your upper arm inserted into your shoulder socket while protecting it.
Speaking in medical terms, the rotator cuff is made up of the supraspinatus, infraspinatus, teres minor, and subscapularis, which all play a part in allowing you to raise and rotate your arm. Your rotator cuff is utilized daily in movements like reaching to grab something above you, carrying groceries, and sports like golf and tennis.
Rotator cuff tear symptoms
Because your rotator cuff moves every day, it's fairly common to experience pain or an injury in this area. Rotator cuff injuries occur through normal wear and tear due to overuse. These injuries are common in those who work jobs with a high level of repetitive physical activity like stocking shelves, styling hair, and assembling products. These injuries are also common in those who play sports involving repetitive shoulder movements like baseball, golf, and tennis.
The most common symptoms of a torn rotator cuff are:
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Aches deep in the shoulder
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Weakness in the arm
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Limited shoulder mobility
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Elevated pain at night
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Grinding and cracking with movement
If you're experiencing these symptoms, you most likely have a rotator cuff or shoulder injury. Getting a proper diagnosis is the next step to relieving your pain and discomfort.
Diagnosing a torn rotator cuff
If you think you might be suffering from a rotator cuff injury, you'll need to visit an orthopedic specialist to get a diagnosis and start your recovery. First, your doctor will likely perform a physical examination, ask you about your pain and how and when it began. After a physical exam, your physician might ask that you get some imaging done in the form of an MRI or x-ray to get an even deeper look at your injury.
Non-operative rotator cuff treatments
Once your provider diagnoses your injury, you'll develop a treatment plan. Depending on the severity of your injury, age, and health, this may include surgery. But if your injury does not require surgical treatment, you'll discuss non-operative treatment methods. The treatment choice varies from patient to patient, but generally includes a combination of the following:
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Rest, ice, compression, elevation (RICE): Your physician will always recommend RICE as an immediate treatment plan, simply because it is a common and effective way to treat many injuries. By resting your shoulder, you give the rotator cuff time to heal. Applying ice to the area will reduce inflammation and numb the injury. Wearing a compression sleeve or otherwise applying pressure will minimize swelling and help blood circulate in the area. And by elevating the injured rotator cuff, you allow blood to access the region, which in turn reduces swelling over time.
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Physical therapy: While you might think that physical therapy is only necessary for surgical recovery, it's not uncommon to see a physical therapist for a rotator cuff injury that does not require an operation. A physical therapist will help you to regain strength in the area through exercise like doorway stretches and lawn mower pulls. These exercises can help restore movement, and once you are comfortable enough, you’ll start using small weights during the exercises to gain strength. The length of your treatment depends on the severity of the injury, but if you must see a physical therapist, you can expect to visit them for a couple of weeks.
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Anti-inflammatory medicines: In combination with RICE or physical therapy, your physician might prescribe some anti-inflammatory medications. This will help to reduce inflammation and relieve some of your discomfort. Depending on the severity, your doctor may refer you to over the counter options or prescribe you a higher dosage that can be picked up from the pharmacy.
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Corticosteroid shot: An injection of cortisone in the shoulder can decrease the pain significantly by reducing the inflammation directly at the source. You'll usually feel relief within a week, and the injection can last up to eight weeks. If your physician recommends a corticosteroid shot, you'll likely be scheduled for a follow-up appointment to see how your pain is after a few weeks. If the shot doesn't help, your provider will explore other options because this injection can only be given two to four times a year.
Surgical rotator cuff treatments
After diagnosis, if your provider decides your injury needs surgical treatment, you'll discuss your options. Some signs that an operation is a more viable option for your injury include:
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Symptoms for over six months
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Significant weakness and low mobility in the shoulder
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Your injury includes a significant tear of over three centimeters
After examining your injury closely, your doctor will likely elect to do one of the following three procedures.
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Traditional open repair: During a traditional open repair, your surgeon will make an incision over the shoulder and detach the shoulder muscle. By separating this muscle, your surgeon will get a better view of the injured tendon. Your surgeon will then repair the damaged tendon, reattach the shoulder muscle, and close the incision. This procedure is done in cases with a large or complex tear. Depending on the size of the tear, you might have to wear a sling for a few weeks, accompanied by a few months of physical therapy.
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Arthroscopic repair: Your surgeon will insert a small camera in your shoulder to get a close view of the injury. Along with the camera, they will insert small surgical tools to repair the injury while using the camera to see. With this non-invasive approach, you will only be left with a small incision because the scope and the surgical tools are incredibly small and don't need much room to enter. An arthroscopic repair is usually an outpatient procedure, meaning you'll likely be able to head home that day.
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Mini open repair: Similar to an arthroscopic repair, your surgeon will make a small incision in the shoulder and insert a tiny camera known as an arthroscope. This is to get a better view of the injury and make minor repairs if needed. After this, your surgeon makes another small incision to repair the injury to the rotator cuff. This approach does not use the camera throughout the surgery like an arthroscopic repair. Instead, the surgeon will have direct access to the tissue. This procedure is less invasive than a traditional repair. You can expect a recovery of six to eight weeks.
If you think you are suffering from an injured rotator cuff or are experiencing shoulder pain, consider making an appointment with a provider from Rothman Orthopaedics. Our specialists will diagnose and start treatments to get you back to living pain-free. Schedule an appointment online or by calling 1-800-321-9999.
