Commonly found in older adults, rotator cuff tears are generally accompanied by shoulder pain. The rotator cuff allows movement of the shoulder joint and also provides stability to the shoulder. Rotator cuff tears can be the result of a variety of different causes, but are mostly found in the elderly, resulting from the normal wear and tear that goes along with aging. Additionally, rotator cuff tears may also be caused by accidents or injuries and repetitive stress on and use of the shoulder or from certain sports activities repeated over a long period of time.
For most patients with rotator cuff tears, pain is the first symptom and is generally associated with certain specific activities, such as raising the arm above the head or trying to lift something from a high place, etc. If the pain continues, there may also be additional symptoms of muscle weakness, as well, and sometimes reduced movement or range of motion and/or a frozen shoulder. Whenever you experience increased pain, you should see a doctor immediately.
Shoulder pain result from various causes. In cases of shoulder pain caused by a rotator cuff tear, patients generally experience pain both in and around the shoulder, and especially on the front and side of the shoulder. Doctors will perform an examination in order to isolate the cause of the shoulder pain and determine whether it is due to a problem in the shoulder or whether it is coming from another part of the body, such as the neck, etc. Other tests that may help your doctor confirm your diagnosis and provide more information about your rotator cuff include x-rays and an magnetic resonance imaging (MRI). The use of x-rays or an MRI will be considered on a patient-by-patient basis, depending on the history and results of the physical examination of each individual.
Treatment of a rotator cuff tear depends on the severity of the injury or condition.
In cases where the rotator cuff is inflamed but not torn, a conservative treatment approach may be used. This approach includes reducing shoulder joint activity and taking anti-inflammatory medication to reduce arm and shoulder pain. These measures are combined with physical therapy. In most cases, this kind of treatment should be sufficient for reducing the pain and improving the condition. Additionally, if your rotator cuff tendinitis is not managed through more conservative treatment, your doctor may recommend a steroid injection. The steroid is injected into the tendon to reduce inflammation, which also reduces pain.
When the results of an MRI show a partial rotator cuff tear, the conservative treatment approach may be used as described above, if the tear does not exceed one-half of the tendon thickness. If the tear depth is greater than one-half of the tendon thickness, however, surgery is recommended for better treatment results. Generally speaking, conservative treatment will be carried out for approximately three to six months, after which, if the patient does not respond to the treatment or there is no change in symptoms, or for example if the pain increases or the patient experiences muscle weakness, these developments would indicate the need for surgery as well.
Full-thickness rotator cuff tears can lead to atrophy of the rotator cuff muscles, fatty infiltration, and possible muscle retraction, causing loss of function in the rotator cuff. Additionally, the size and depth of the tear will continue to increase, resulting in loss of shoulder stability and changes in the distribution of force to the shoulder joint surface, leading to further degeneration of the shoulder joint. Therefore, in cases of full- thickness rotator cuff tears, surgical treatment is recommended in order to repair the tendons and muscles in the rotator cuff.
We have found that some elderly patients may have rotator cuff tears without experiencing any of symptoms. This situation could be due to the rebalancing of the muscles surrounding the patient’s shoulder, causing the shoulder joint to remain stable and its functions to be retained without displaying the usual symptoms. However, in cases where there is pain along with a rotator cuff tear and non-surgical treatment is carried out, even if the pain decreases and the mobility is improved, the amount of weakness in the shoulder muscles generally remains the same or worsens. In addition, improvements in the symptoms in such cases have not been found to last in the long term and/or may revert back to the same or even worse levels of discomfort after some time. When monitoring a patient’s symptoms over a long period of time, increased degeneration of the shoulder joint is often found. Changes that occur in the rotator cuff when a tear has been left untreated for a long period of time include tendon retraction and muscle atrophy. These changes are limiting factors and make it impossible for the rotator cuff to be repaired.
The type of surgical treatment chosen by the doctor to treat the condition is dependent upon the type of tear and the condition of the rotator cuff itself. One surgical procedure that has been developed for the repair of rotator cuff tears involves the use of a small camera that is inserted into the shoulder to see and repair the rotator cuff tear. This is called an arthroscopic rotator cuff repair. The advantages of this type of surgery are: reduced pain in the shoulder muscles, smaller incisions, and less postoperative pain. This type of surgery also allows for a much quicker return to normal function than would be possible with traditional open surgery, and it can also mean less time spent recuperating in the hospital as well. If, however, the condition of the rotator cuff is very poor or the tear is too large to repair, combined with shoulder joint deterioration, the shoulder replacement surgery will offer better treatment results.
The latest advancements in surgical technology, fixation techniques and related equipment, combined with physical therapy developed to meet the specific needs of each patient and carried out with good cooperation from the patient can all help patients recover from rotator cuff injuries and tears and return to their normal activities and lives as quickly as possible.
Faculty of Medicine Ramathibodi Hospital, Mahidol University , 2008