By: Brian Lee, MD
Shoulder pain from a rotator cuff injury can significantly disrupt your daily activities or favorite sports. This common condition, especially among athletes and older adults, can cause significant discomfort and limit mobility. This article will answer ten frequently asked questions about rotator cuff injuries, exploring everything from causes and diagnosis to treatment options and recovery tips. With knowledge and proper guidance, you can conquer shoulder pain and return to living an active life.
- What is a torn rotator cuff, and what causes it?
The rotator cuff is a group of four tendons that attach to the humerus bone and provide shoulder movement and stability. A “torn rotator cuff” is tearing one or more of the tendons involved in its function. Typically, this type of shoulder injury occurs due to wear and tear. However, it can also be the result of a traumatic injury resulting in tendon rupture.
- What are the symptoms of a torn rotator cuff? How might those symptoms differ from other shoulder issues, like frozen shoulder or impingement?
Shoulder pain and weakness are typical symptoms of a rotator cuff tear. Depending on the tendons involved, a clinician can perform specific physical examination tests to detect a rotator cuff tear. However, not all such tears cause pain or weakness. For example, in one study evaluating people who have never experienced shoulder pain, half the patients over 60 had rotator cuff tearing and no symptoms!
Shoulder impingement can sometimes be challenging to differentiate from a torn rotator cuff as it can cause pain and limited motion. But sometimes, people with rotator cuff tears will develop more weakness than those with impingement. Frozen shoulder (also known as adhesive capsulitis) causes stiffness from an inflamed joint capsule. People with frozen shoulder will generally have stiffness and pain but won’t have weakness within their range of motion. Patients with shoulder arthritis will also experience stiffness like a frozen shoulder but caused by degeneration of the cartilage in the joint.
- How is a torn rotator cuff diagnosed?
In addition to a detailed physical examination, magnetic resonance imaging (MRI) is the most common way to diagnose a rotator cuff tear. In contrast to an X-ray (which doesn’t show soft tissue), an MRI allows a provider to assess not only a rotator cuff tear but also aids in examining the health of the muscles and implications for treatment options. Ultrasound, mainly when performed by a skilled ultrasonographer, can also be used to diagnose a rotator cuff tear and computed tomography (CT) scans, particularly when aided by contrast injected into the joint.
- What treatments are available for a torn rotator cuff?
Physical therapy/rehabilitative exercises can relieve pain and improve function in some patients. Cortisone injections can ease pain and make performing strengthening exercises easier in patients. More recently, clinicians have utilized platelet-rich plasma (PRP) and bone marrow aspirate (BMA) injections to treat rotator cuff tears. Surgical treatment of a torn rotator cuff can involve repair of the tear using sutures to tie the tendon back to the bone or other reconstructive options like tendon transfers or shoulder replacement for large, otherwise irreparable tears.
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- When someone says they would like to heal a torn rotator cuff naturally, does this usually mean they want to do it without surgery?
- When someone says they would like to heal a torn rotator cuff naturally, does this usually mean they want to do it without surgery?
Yes, when a patient expresses an interest in natural healing, I discuss options such as physical therapy and PRP/BMA injections. However, these two non-surgical treatment options won’t result in the reattachment of a fully torn, retracted rotator cuff tendon. I always take the time to discuss with patients the potential consequences of leaving a tendon torn. Over time, large tears can become irreparable due to tear enlargement, scarring, and muscle atrophy.
- How often is surgery required to repair a torn rotator cuff?
During a rotator cuff repair, a surgeon reattaches the tendon to the bone using sutures. While technology has advanced to include arthroscopic techniques and maximizing biologic factors to promote healing, not all tendons heal after surgery. Surgeons have and continue to perform extensive research in identifying risk factors for patients who don’t heal after surgical rotator cuff repair. Thus, more options to promote healing continue to arise. The good news is that when a repair surgery is successful, the chance of re-tearing a healed rotator cuff repair is extremely low.
- What’s the recovery time for a torn rotator cuff (without surgery)?
Non-surgical healing time for a torn rotator cuff is highly variable depending on a patient’s activity level, age, tear size, and multiple other factors. In general, the average patient with the average rotator cuff tear may begin returning to normal activities 6-8 weeks post-injury and initiating rehabilitation exercises. However, not all patients have adequate results with nonoperative management.
- What is the role of physical therapy in healing a torn rotator cuff?
Rotator cuff tears, due to their location in the body and lack of blood supply to the area, do not heal naturally (like a cut on our skin would). So, if we define ” healing ” as a fully torn tendon becoming reattached, physical therapy cannot heal a torn rotator cuff. However, suppose we classify “healing” as a patient who no longer has pain or functional limitations. In that case, physical therapy can aid patients in regaining motion and strength (particularly by strengthening the other shoulder muscles that are still intact).
- Can we do anything to prevent a rotator cuff injury?
Because the rotator cuff is vital to shoulder motion, we have not found specific nutritional supplements or activity avoidance to prevent rotator cuff injury. However, if performing specific activities causes shoulder pain and weakness, I recommend consultation with a specialist to ensure a tear hasn’t developed.
- Are there other tips or information about managing a torn rotator cuff?
As an orthopedic surgeon specializing in the diagnosis and treatment of should injuries, I’ve witnessed exciting advancements in the surgical treatment for torn rotator cuff tears. If you suspect a shoulder injury, it’s crucial to consult a shoulder specialist to ensure you receive the best care possible. While cortisone injections are commonly performed, they can potentially worsen a rotator cuff tear in the long run. Specialized training and practice are even more critical when considering surgical treatment. For example, if a tear is not reparable, a specialist can typically decide intraoperatively to perform an alternate reconstructive procedure like a tendon transfer or capsular reconstruction, a decision that would have been discussed with you ahead of time.
If you suspect a rotator cuff tear, don’t hesitate to consult a healthcare professional for a proper diagnosis and to discuss the best course of action for regaining shoulder strength and function. Remember, knowledge is power, and with the correct information and approach, you can conquer shoulder pain and get back to enjoying the activities you love.
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Dr. Brian Lee email answers provided on 5/28/24
