A Tear of the Muscles and Tendons of Your Shoulder
What is rotator cuff disease?
Rotator cuff disease is a class of shoulder pathology that can range from rotator cuff tendonitis to a full tear in the rotator cuff tendons. Inflammation and swelling caused the bony structures (bone spurs) of the shoulder rubbing on the rotator cuff can cause a progression to a rotator cuff tear.
A rotator cuff tear is a tear in the tendon that attaches to the humerus. The rotator cuff is a structure that is made up of 4 major muscle tendon units that combine to form one big tendon we call the rotator cuff. The major tendon is called the supraspinatus tendon.
You can have a partial tear where the tear is involved in a portion of the rotator cuff or a full-thickness tear where it is all the way through.
How does it occur?
Rotator cuff tendonitis commonly occurs from repetitive motions of the shoulder joint from cleaning, painting, throwing, swimming, or just plain work. Rotator cuff tears also may occur acutely from a falling with an out-stretched hand or lifting a heavy object. Also, degenerative tears may occur from the wearing down of the rotator cuff. These can occur from repetitive stress, lack of blood supply, or bone spurs.
Rotator cuff tears commonly occur secondary to shoulder impingement syndrome.
What are the symptoms?
The symptoms of a rotator cuff tear are pain at rest and night pain, weakness lifting and rotating your arm, pain with lifting, and crepitus or crackling sensation with movement of your shoulder.
Difficulty sleeping, taking off a shirt or coat, putting on a seatbelt or even washing and/or combing your own hair may become difficult and affect your daily activities. If you are suffering from any of these symptoms for greater than 2-4 months, it is very likely that you are suffering from one of the above-mentioned shoulder pathologies.
How is it diagnosed?
Rotator cuff disease is diagnosed with a detailed history and physical exam. You will be examined for pain, tenderness, range of motion (ROM), and weakness. An injection into your shoulder can help differentiate a rotator cuff tear, impingement syndrome or other external sources of shoulder pain.
X-rays of the shoulder will be done to examine the bones, and an MRI will be performed to check for a rotator cuff tear and other soft tissue pathologies such as the integrity of your labrum and biceps tendon.
How is it treated?
Rotator cuff disease can be commonly treated non-surgically in some cases with rest, activity modification, non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy and steroid injections in an orthopedic clinic.
If conservative measures are not effective, then surgical treatment is the next step in getting you well. Minimally invasive arthroscopic surgery is utilized to reattach the rotator cuff to the proximal humerus or to clean off problematic, inflamed areas of tendon and bone. Any bone spurs associated with impingement syndrome are removed as these commonly abrade your rotator cuff, causing the tear. The procedure takes about 45 minutes to an hour with an average time in the facility of 5 hours total.
What is the recovery time?
Recovery varies based on the extent of the condition and repair done at the time of surgery. Our patients wear a sling for 24 hours after surgery. After that they remove the sling and start an exercise program which can be done at home. We will instruct you on simple home exercises you will do three times a day. At your 2-week follow-up appointment, we will advance you to Phase II exercises. We may recommend outpatient physical therapy at that time, however, most of our patients are able to have a full recovery with Dr. Bramlett’s simple home exercise program. Most patients resume light-duty work within a few days and progress to full-duty in 3 weeks to 3 months. The longer you delay surgery, the longer your recovery time will be.
We are here to help. If you believe you are suffering from one of these conditions, we would love to deliver a diagnosis, get you treated and get you moving again.