This post was written by Michael Rosen, DO, PPG – Orthopedics, Angola, Indiana.
The rotator cuff is a group of muscles that helps to move the shoulder. With any muscle, there can be aches and pains with aggravating activities, which often resolve on their own. But when symptoms are more prolonged, it could signal tendinitis or a tear of the rotator cuff. In this post, we dig into the latter and what can be done to get relief.
Causes
A tear can happen over time from normal wear and tear, or it can happen after a traumatic injury.
Symptoms
The symptoms vary and may simply be associated pain, but weakness and pain are the most common presenting symptoms.
Diagnosis
A rotator cuff tear can be diagnosed by gathering a thorough history and performing a physical exam. There are numerous physical exam techniques that can isolate each muscle of the rotator cuff and allow for adequate testing to assess the integrity of the muscle and tendon. An x-ray is sometimes helpful to identify changes around the shoulder, which may signal a possible rotator cuff tear. If we suspect a tear is present, an MRI is the most helpful imaging technique to adequately visualize the rotator cuff.
There are different severities of rotator cuff tears. Some may simply be tendinitis, while others will be diagnosed as a partial or full tear. In a full-thickness tear, we also need to evaluate the position of the tendon and the amount of retraction, which would help determine the ability for the tendon to heal back to the normal position.
Treatment
We are often able to treat shoulder pain or rotator cuff injuries with conservative treatment, which includes activity modification, over-the-counter anti-inflammatory medications, and home exercises or physical therapy. A steroid injection in the shoulder may also help reduce inflammation and alleviate pain. Other types of injections are available as well.
When symptoms fail to improve with these conservative measures, surgery may be necessary for complete recovery. Based on the type of tear, sometimes it’s more beneficial to try a longer course of conservative treatment if there is good potential for the injury to heal on its own. However, full-thickness tears cannot heal on their own and often require surgery. Over time, full thickness tears have been shown to progress and become enlarged, which make repair and recovery more difficult.
It used to be that rotator cuff tears were fixed surgically through an open incision. Now, rotator cuff surgery is more commonly performed with arthroscopy through very small, minimally, invasive incisions. In more severe cases, different reconstructive options may be necessary.
Recovery
Following rotator cuff repair, recovery takes several months, and a sling is often necessary for the first few weeks to protect the repair. Physical therapy is essential and starts shortly after surgery. Most patients can return to normal activities within 4 to 6 months after surgery, but full recovery may take up to a year for larger tears.
Prevention
While some rotator cuff tears are unavoidable, certain techniques can be utilized to try to prevent injury. Low impact exercise can help to strengthen the muscles and tendons around the shoulder and provide better support. Proper lifting technique can minimize risk as well as limiting overuse. Additionally, you should always warm up before physical activity to enhance flexibility and reduce injury risk.
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