Rotator Cuff Tears

Rotator Cuff Tears
Dr. James E. Tibone Sports Medicine Specialist Los Angeles, California

Dr. Tibone holds the Moss Foundation Professorship in Sports Medicine in the Department of Orthopaedic Surgery at the Keck School of Medicine of USC and he is the medical director for USC's Athletic Department. Dr. Tibone is an internationally recognized expert in sports injuries of the shoulder, knee and elbow and total... more

The shoulder is a complex joint. It consists of a round ball on the top of the humerus or arm bone.

This connects to the glenoid or shoulder socket which is part of the shoulder blade. The rotator cuff tendons connect to the top of the humerus. They originate from muscles attached to the shoulder blade or scapula.

The rotator cuff consists of four muscles and tendons that attach on the top of the humerus or arm bone. They are the subscapularis, supraspinatus, infraspinatus, and Teres minor. Rotator cuff problems are the most common condition causing shoulder pain that I see in my office. Patients present at all ages with rotator cuff problems that cause pain and loss of function.

Rotator cuff problems can occur from an injury, degeneration from aging, or from bone spurs that impinge on them. This causes pain on the top and front of the shoulder that radiates down the lateral aspect of the arm towards the elbow. This may make it difficult and painful to lift the arm. Rotator cuff problems also cause difficulty sleeping and are worse at night.

Most rotator cuff tears can be treated conservatively without surgery. It is important that these rotator cuff problems be treated early to avoid surgical intervention. If someone has a shoulder problem that doesn't resolve on its own within six weeks, they should see a orthopedic surgeon. Conservative treatment consists of anti-inflammatory medications, Cortisone injections, and physical therapy. Inflammatory medications are usually taken for 2 to 3 weeks to help alleviate the pain in the shoulder. A Cortisone injection can also help alleviate the inflammation and decrease the pain especially at night and help the patient sleep. Only one or two Cortisone injections are recommended to avoid complications from the Cortisone.

The mainstay of conservative care for rotator cuff problems is physical therapy. Physical therapy is usually recommended for two or three times per week for 6 to 12 weeks. The physical therapist works on regaining full range of motion of the shoulder and improving the function of the shoulder. This is accomplished by strengthening the rotator cuff muscles and the muscles that attached to the shoulder blade or scapula. Most patients notice a responsive with decreased pain and improved function within six weeks. Physical therapy works best when the shoulder problem is treated early before it becomes a chronic condition. When the rotator cuff tears are small, physical therapy and conservative care are usually successful.

When the tears become large and the tendon retracts from the bone, surgery may be necessary. This is best performed by an orthopedic surgeon who specializes in shoulder conditions. The surgery can usually be performed as an outpatient done through the arthroscope without making a large incision. The surgery usually lasts 1 to 1 1/2 hours. The patient wakes up in a sling with a small foam pillow under the elbow. The sling is worn for 1 to 6 weeks depending on the size of the tear. The patient usually needs pain medication for the first week after the operation. Once the sling is removed, physical therapy is begun and usually lasts for three months. The physical therapy first regains motion in the shoulder for the first six weeks after the surgery and then introduces light weights and bands. At 12 weeks after the surgery, the weights are progressed to tolerance. Physical therapy may last up to six months. After six months the patient usually is fully recovered and can resume all work and sporting activity.

Complications of rotator cuff surgery can occur. These include infection, stiffness, and failure of the rotator cuff to heal. Infections are rare and incur in less than 1% of the cases and can usually be treated with antibiotics without any long-term sequela. Stiffness can occur in some cases but usually resolves within 6 to 12 months and further surgery is rarely needed. Some rotator cuffs fail to heal despite the surgery, but patients still have decreased pain and increased function and a second surgery is usually not needed. The success rate of rotator cuff surgery is greater than 90% for relief of pain and improving function. This occurs even if the rotator cuff tendon does not heal fully.

In summary, rotator cuff problems should be treated early by an orthopedic surgeon. If treated early, the majority of rotator cuff problems can be treated conservatively with a good physical therapy program. Surgery is usually only necessary in a small percentage of cases and is usually successful. If a patient neglects his rotator cuff tear, this may lead to arthritis and require a shoulder prosthesis which is a much larger operation with an increased incidence of complications. Your shoulder is important for having a functional arm.