HCA Virginia Physicians
October 24, 2019

Shoulder Pain? You May Have a Torn Rotator Cuff

Dr. Rahman Kandil


Shoulder pain is a debilitating condition. The shoulder is such an integral part of the body that every movement can radiate discomfort, at times. The rotator cuff is a part of the shoulder and is made up of muscles and 4 separate tendons that fuse together to surround the shoulder joint. The muscles help to move the arm at the shoulder and to stabilize the joint. The muscles are connected to the shoulder bone by tendons, which are strong, flexible cords. These muscles or tendons may become damaged from long term overuse or from injury.

Rotator cuff injuries include:

  • Tendinitis (inflammation)
  • Straining
  • Tearing

Causes of a Torn Rotator Cuff

Causes of a rotator cuff injury include:

  • A direct blow to the shoulder area
  • Falling on an outstretched arm
  • Chronic degenerative wear and tear on the tendons. Arthritis may decrease the space for the tendons, and chronic instability of the humerus, the bone that runs from the shoulder to the elbow, may traumatize the tendons.
  • Repetitive overhead motion of the arm, often seen in sports like swimming, baseball (mainly pitching), and tennis.

Risk Factors for a Torn Rotator Cuff

A risk factor is something that increases your chance of developing a certain condition. A rotator cuff injury is more common in people aged 40 years and older. Other risk factors for rotator cuff injury include:

  • Heavy lifting
  • Abnormalities of the shoulder, rotator cuff anatomy, or function
  • Activities that involve repetitive overhead arm motion, such as throwing
  • Weakened shoulder muscles from inactivity or a previous injury

Symptoms

Rotator cuff injury may cause:

  • Recurrent, constant pain, particularly when reaching overhead
  • Pain at night that prevents you from sleeping
  • Shoulder muscle weakness, especially when lifting the arm
  • Popping or clicking sounds when the shoulder is moved
  • Limited range of motion in the shoulder joint

Diagnosing Rotator Cuff Injuries

Your physician will ask about your symptoms and medical history, and a physical exam will be done. Particular attention will be given to your shoulder. You will be asked to move your shoulder in several directions.

Other diagnostic tests may include:

  • Ultrasound
  • Arthrogram
  • MRI scan
  • Arthroscopy

Treatment Options for Rotator Cuff Repair

The treatment will depend on the extent of your rotator cuff injury, level of pain, and the amount of immobility. The first step is usually a nonsurgical approach.

Nonsurgical

Nonsurgical approaches may include:

  • Rest to help the shoulder heal; an arm sling may be used to help rest the shoulder area
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, to control pain and inflammation
  • Topical pain relievers, like creams or patches, that are applied to the skin
  • Corticosteroid injections to help reduce pain and inflammation
  • Injection of platelet rich plasma (PRP) to promote healing
  • Ice to help relieve pain and inflammation
  • Physical therapy to help strengthen and increase motion in the shoulder area

Surgical

When a rotator cuff injury that does not respond to rest and physical therapy treatment, surgical repair may be necessary. This can occur when there is a complete tear in the tendon or with chronic pain and weakness from a partial tear in the tendon. Surgery is performed using general anesthesia and typically takes 1.5 to 2 hours. Surgical options for rotator cuff injuries are:

  • Acromioplasty: surgery on the bony structures that impinge the rotator cuff. Surgery can be arthroscopic or open.
  • Arthroscopy: A few small incisions are made in the shoulder. A narrow tool called an arthroscope is inserted through an incision. The scope has a tiny camera to allow the doctor to see inside. Other small instruments are inserted through the other incisions, and are used to repair the tendon or muscle. After the procedure, the incisions are bandaged and your arm is placed in a sling or brace to immobilize the joint.
  • Mini-Open Repair with Arthroscopy: This combines arthroscopy with an incision in the shoulder joint. Through the incision, larger tears in the tendons or muscles can be sutured.
  • Open Surgery: Open surgery may be used to repair the injured tendon or muscle in more severe cases. A tissue transfer or a tendon graft can be done during surgery if the tear is too large to be closed together. In the most severe cases, a joint replacement may be necessary.

Recovery

The rotator cuff will take several months to heal. It may take some time before you can raise your arm above your shoulder, and may be up to 1 year before you can hold your arm above your head and do work with reasonable strength. An aggressive and consistent physical therapy and exercise program is the key to a faster recovery.

Possible Complications from Rotator Cuff Repair

Problems from rotator cuff repair surgery are rare, but all procedures have some risk. Your doctor will review potential problems, like:

  • Infection
  • Excess bleeding
  • Blood clots
  • Reaction to anesthesia
  • Weakness or numbness in shoulder joint
  • Detachment of the shoulder muscle
  • The operation does not improve function

Factors that may increase the risk of complications include:

  • Smoking
  • Alcohol abuse
  • Obesity
  • Diabetes or other chronic disease

Preventing Rotator Cuff Injuries

To help reduce your chance a rotator cuff injury:

  • Avoid overhead repetitive motion.
  • Limit duration of work that involves moving hands above shoulders, using shoulders in extreme outward rotation, or vibrating tools.
  • Avoid heavy lifting.
  • Exercise regularly to strengthen the muscles around the shoulder joint.

If you would like to make an appointment with Dr. Rahman Kandil to discuss shoulder or joint pain that may need to be addressed, go to Dr. Kandil's physician page or call (703) 665-2720 and we will be happy to assist you.

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