Rotator Cuff

Shoulder injuries are common, can occur at any age, and for various reasons. A fall, sports injury or aging can cause a rotator cuff tear. The pain may be so severe that the injured person is unable to participate in sports or perform basic life activities, like showering, or shopping.

What is the Rotator Cuff?

The rotator cuff is a group of muscles and their tendons that cover the head of the humerus (the upper arm bone). They work together to stabilize the shoulder, keep the shoulder in its socket and provide the ability to rotate and lift the arm.

Rotator Cuff Tears

When a tendon tears, it may partially or fully detach from the upper arm bone. When it tears it causes pain and weakens in the shoulder.

A partial tear is damage to the soft tissue. But the cuff is still partly attached.
A full thickness tear is a complete tear. The tendon is torn away from the bone.
An acute tear from a fall, or accident can be accompanied by other shoulder injuries like a broken collarbone or dislocated shoulder.
Degenerative tears occur from normal wear and tear, and typically occur in the dominant arm. Risk of a tear increases with age.
Repetitive stress on the same shoulder overtime can result in overuse tears. They are common in baseball, tennis, rowing and weight lifting. Certain jobs and routine chores can also cause these tears.

Risk factors

Age
Sports
Construction jobs
Family history- genetic component

Symptoms

Pain may be dull ache deep in shoulder at first, with progressively worse pain with use
Often the pain is significant and interferes with sleep
Pain may occur when lifting or lowering the affected arm
A crunching sensation when the shoulder is moved in certain positions
Weakness when lifting or rotating the arm

When to see a Doctor

When there is immediate, intense pain and loss of motion after injury
When pain lasts more than a few weeks. Long- lasting pain is a sign that surgical repair is needed.
When pain and weakness interferes with daily activities
When there is chronic shoulder and arm pain
When the patient continues to use the arm with pain, the risk is further damage to the cuff and enlarging the tear.

The Orthopedic Evaluation

During an exam the surgeon will need to know a patient’s symptoms and medical history. A physical exam will reveal tenderness. The patient will receive range of motion and strength testing. The surgeon will look for other possible causes of pain including a pinched nerve or arthritis.

X-rays will show bone spurs or other causes of shoulder pain. An MRI will show soft tissue damage, and reveal the tear, its location and the size, and can also show how old or new the tear is, and the quality of the cuff muscles.

The surgeon may wish to evaluate the shoulder structure and compare the injured shoulder to the uninjured shoulder in real time with ultrasound.

At South County Orthopedic Specialists (SCOS) our Fellowship Trained orthopedic surgeons offer their expertise in the newest treatment techniques to their patients. In Orange County California, patients who suffer continuous shoulder pain that prevents them from participating in daily activities ranging from playing sports to playing with their grandchildren, will receive state-of-the-art, compassionate, and effective care.

Nonsurgical management

About fifty percent of patients achieve pain relief and improved function with nonsurgical management. Shoulder strength does not improve without surgery.

Rest, ice and PT
Modified activity
NSAIDS help with pain and swelling
Strengthening exercise and PT will restore and strengthen shoulder. Improve flexibility and range of motion. Stronger muscles will help support the shoulder and relieve pain, as well as prevent future pain.
Steroid injections may be offered if rest, medication and therapy don’t relieve pain.

Nonsurgical management is valuable because it avoids surgery, infection, permanent stiffness, anesthesia complications, and a lengthy recovery. That being said it won’t improve strength, may increase tear size, and may require limited activities.

Indications for Surgical Intervention

Recent acute injury and rotator cuff tear
Symptoms lasting six to twelve months for chronic or degenerative tears
When pain does not improve with nonsurgical management
There is a large tear- over 3 cm (about 1.18 inches)
Significant weakness or loss of shoulder function

The goal of surgery is to reduce pain and restore function.

Surgical Options

Surgery to reattach the tendon to the head of the upper arm bone.
A partial tear may need only trimming called debridement.
Complete tear by stitching the two parts back together.

The type of repair depends on size of tear and your anatomy and quality of your tendon tissue and bone. If there are other shoulder injuries, they will be repaired at the same time.

Surgical Techniques

Arthroscopic repair uses a small camera, small incisions, and guided instruments. It can be done as an outpatient. This less invasive approach can release a pinched nerve, reattach tendon to bone, restore anatomy, remove bone spurs and smooth the damaged tendon.

Arthroscopic repair to remove loose pieces of tendon and other debris to allow the rotator cuff to move smoothly. This is called a debridement or decompression.

A mini-open surgery is an older but equally successful option that includes arthroscopy and open surgery. It uses arthroscopy to assess and treat damage to the joint including bone spurs. After the other damage is fixed, repair to the rotator cuff is accomplished through a small incision without the arthroscope.

Open surgery is less common but may be indicated in complex tears, revision surgery or when a tissue graft is required. During open surgery a portion of the deltoid shoulder muscle is detached to access tendon. Then, the surgeon will remove bone spurs, and loose tendon fibers and conduct other repairs as needed. Some tears can be sewn together and then repaired back to the top of the upper arm bone. Large tears may require complex reconstruction or tendon transfer, and require a longer recovery time.

Tendon transfer may be needed where torn tendon is so damaged that it can’t be reattached. A nearby tendon may be used as the replacement.

Reverse shoulder replacement is the procedure for massive cuff injuries that cannot be repaired. Here the rotator cuff muscles no longer function correctly and are too damaged or atrophied to be repaired. Since there is no cuff to support the arm and provide function, the surgeon will use the deltoid muscle instead, to provide strength and power to move the shoulder joint.

Outcome

All of these techniques provide similar results: pain relief, improved strength and function, and patient satisfaction. Surgical expertise is necessary to achieve satisfactory results.

Recovery time

Complete recovery takes months. Improved function and range of motion and strength will take at least 4-6 months. Patients must be committed to rehabilitation to achieve a satisfactory result.

Our SOCS shoulder specialists include our sports medicine fellowship trained team Dr. Scott Graham, Dr. Chris Veneziano and Dr. Nimish Kadakia who are experts in arthroscopic repairs for the rotator cuff. They are specially trained to diagnose and treat rotator cuff tears. Dr. Ari Youderian, a fellowship trained orthopedic shoulder specialist, specializes in the complex reconstructions including both arthroscopic and open rotator cuff repairs, tendon transfers and reverse shoulder replacement.

Shoulder and Elbow Specialists

Ari Youderian, MD

Dr. Youderian is a board-certified, orthopedic surgeon who specializes in care of the shoulder, upper arm and elbow. Read Dr. Youderian’s biography.

Sports Medicine Shoulder Specialists

Scott Graham, MD

Dr. Graham is our Sports Medicine specialist, providing advanced and minimally invasive care for all sports medicine injuries. Read Dr. Graham’s biography.

Christopher Veneziano, MDS

Dr. Veneziano sees Orange County, CA patients for general orthopedic problems and injuries, and specializes in sports injuries. Read Dr. Veneziano’s biography.