Breaking Down Your Rotator Cuff Injury
Chronic, deep shoulder pain, difficulty raising the arm, and shoulder weakness are all signs of a serious underlying issue. Often, these are signs of a shoulder injury, such as a rotator cuff tear. The rotator cuff is a group of 4 muscles and associated tendons that wrap around the shoulder joint. Along with protecting the shoulder joint, the rotator cuff plays an important role in connecting the upper arm to the shoulder blade. Rotator cuff tears are common injuries, that occur when at least 1 of these tendons is damaged or torn. With almost 2 million rotator cuff tears occurring yearly, many of these require surgery. Knowing when to move forward with surgery helps with improved, long-term shoulder function.
Diagnosing your rotator cuff tear
Some individuals go months with untreated shoulder pain, hoping the issue goes away naturally. Yet, most cases are partial or full-thickness rotator cuff tears. Anyone with chronic pain lasting days or weeks should seek medical help immediately. Rotator cuff tears can be injury-related or degenerative due to years of wear and tear. A doctor, such as an orthopedic specialist, will perform a series of tests and scans to diagnose the injury and start treatment. Some patients may need a magnetic resonance imaging (MRI) scan for a more detailed analysis. The cause and severity of the rotator cuff tear guide the surgeon on an effective care plan.
Initial treatment strategies
Rotator cuff tears require a comprehensive treatment plan. The medical team will recommend long periods of rest and pain medication to manage inflammation. Activities that can aggravate the shoulder, like heavy lifting or sports, are prohibited. The patient will wear a shoulder brace or sling to limit movement and facilitate healing. Physical therapy (PT) is essential to recovery and is the first strategy used before surgery. The exercises, stretches, and other modalities improve shoulder strength, boost range of motion (ROM), and help with pain management. Some doctors will recommend additional strategies like corticosteroid injections or regenerative medicine.
How effective is non-surgical treatment?
Non-surgical treatment is the first strategy for a reason. PT, rest, and pain management are effective strategies for treating rotator cuff tears. Statistics show that at least 75% of patients who undergo non-surgical treatment see success and improved healing. These techniques are particularly effective for partial rotator cuff tears. The challenge lies in the timeline for recovery. Non-surgical treatment can take 6-12 months for a full recovery. Patients may experience periods of pain, discomfort, and limited mobility during this period. Non-surgical treatment requires consistency, as missing sessions can weaken the shoulder or worsen the injury.
Indicators for surgical consideration
If non-surgical treatment fails to improve symptoms, surgery is the right move. In many cases, pain and reduced mobility continue after 6-12 months of treatment. Significant shoulder weakness and loss of function indicate a severe tear that needs surgical attention. A large tear exceeding 3 centimeters (cm), or cases where the tendon fully detaches from the bone should be handled with surgery. These cases are often after an acute injury or sudden accident. Surgery ensures the muscles are not severely affected. Repeated tears are another sign that surgery is needed to reinforce the shoulder. The surgeon will discuss the reasons for surgery and provide options for the best outcome.
Types of rotator cuff surgery
Patients will have the option of open rotator cuff repair or arthroscopic surgery. Traditional open surgery uses a large incision over the shoulder to access the damaged tendon. The surgeon has direct visualization of the shoulder and can reattach the tendon to the bone. Arthroscopic surgery uses multiple small incisions called portals to access and repair the shoulder. A scope goes through 1 of these portals, which uses a tiny lighted camera that sends images to an external monitor. The surgeon can then use additional tools to repair the torn tendon. Traditional surgery works for significant tears in multiple locations but has a lengthy recovery. Arthroscopic repair is an outpatient procedure ideal for degenerative tears or smaller tears. Some cases can benefit from a mini-open repair, which combines traditional and arthroscopic techniques.
Make an informed decision
Rotator cuff tear patients are concerned about long-term shoulder pain and function. An effective treatment strategy helps with the best possible outcomes. Minor tears can benefit from pain management, rest, and consistent physiotherapy. More severe tears and acute injuries, however, should seek surgical intervention. If non-surgical treatment fail, patients should explore other options. Surgery is especially useful for patients who participate in sports or work that require maximum use of the shoulder. There is a faster return to activities thanks to arthroscopy. Take all factors into consideration then choose surgery as needed.
