ROTATOR CUFF TEAR: INJURY, SYMPTOMS, CAUSES, DIAGNOSIS, SURGERY, AND RECOVERY
A rotator cuff tear in adults is a common cause of disability and pain. Every year, around two million individuals in the U.S. see their doctors because of a rotator cuff injury, according to the American Academy of Orthopaedic Surgeons.
What is a Rotator Cuff?
A rotator cuff is a set of tendons and muscles surrounding your shoulder joint that keep your upper arm bone's head firmly within your shoulder's shallow socket.
What Is a Rotator Cuff Tear?
Rotator cuff tears are common injuries, particularly in sports like tennis or baseball, as well as in jobs like cleaning windows or painting. It typically occurs gradually from regular wear and tear or with repetitive arm motion. But, it could also occur suddenly if you lift a heavy object or fall on your arm.
There are a couple types of rotator cuff tears:
- A complete tear: These pull the tendon off your bone or go all the way through your tendon.
- A partial tear: These occur when there’s damage to one of your muscles forming your rotator cuff.
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Common Causes of a Rotator Cuff Injury
Injury and degeneration are two primary rotator cuff tear causes.
- Acute tear: If you lift a heavy object with a jerking movement or if you fall down on an outstretched arm, you could tear your rotator cuff. An acute tear can also occur with a shoulder injury like a dislocated shoulder or broken collarbone.
- Degenerative tear: Many tears are due to the tendon wearing down gradually. This degeneration occurs naturally as you age. You'd experience a rotator cuff tear more so in your dominant arm. If you experience a degenerative tear in a single shoulder, you have a higher chance of experiencing one in your opposite shoulder, regardless of whether you're experiencing pain in the shoulder.
Various factors contribute to chronic or degenerative rotator cuff tears:
- Lack of blood supply: As you get older, there’s a reduction in the supply of blood in your rotator cuff tendons. When you don't have a decent supply of blood, it impairs your body's natural ability of repair tendon damage, ultimately leading to a tendon tear.
- Repetitive stress: Repetitive shoulder movements can stress your rotator cuff tendons and muscles. Tennis, baseball, weight lifting and rowing are examples of certain sports that could place you at risk for overuse tears. Different routine chores and jobs could also cause overuse tears.
- Bone spurs: As you get older, bone overgrowth (bone spurs) can develop on the underside of your acromion bone. When you lift your arms, the spurs can begin rubbing your rotator cuff tendon. You call this shoulder impingement and it can weaken your tendon over time, making it more likely to tear.
You can also have a labrum and bicep tear at the same time that may require surgery at the same time.
Overhead activities can place you at risk for a rotator cuff tear. Athletes are particularly susceptible to overuse tears, especially baseball pitchers and tennis players. Carpenters, painters and other professionals who perform overhead work have a higher risk for tears.
While overhead work- or sports-related overuse tears also occur in younger individuals, many tears in young individuals are due to traumatic injuries like falls.
Rotator Cuff Pain
Rotator cuff pain is usually caused by a torn tendon or an inflamed tendon (tendinitis). Your pain can range from an aching, dull sensation to sharp pain that spreads down your upper arm when you sleep on the impacted side or reach overhead. The pain's intensity, interestingly, doesn't necessarily match up with the degree of your injury. Rotator cuff pain, less commonly, might be due to a condition known as a rotator cuff tendinosis when your tendons become worn down or frayed because of overuse or increasing age.
Torn Rotator Cuff Symptoms
Torn rotator cuffs can't always be felt. In some cases, however, you may experience torn rotator cuff symptoms, such as:
- Experiencing pain when lying on your arm or moving it in certain ways
- Difficulty raising your arm
- Having weakness in the shoulder
- Front shoulder pain
- Not being able to lift things like normal
- Hearing popping or clicking when moving your arm
If you experience any of these symptoms, see your doctor. If you leave a torn rotator cuff untreated, you could experience more serious issues over time like arthritis or a frozen shoulder that's more difficult to treat.
Can A Torn Rotator Cuff Heal On Its Own?
A mild rotator cuff injury does tend to heal on its own when you care for it properly. In fact, many rotator cuff tears don't require surgery. Steroid injections, anti-inflammatory medicine and physical therapy might help to treat rotator cuff tear symptoms. Treatment goals are to restore strength and relieve pain in the involved shoulder.
While most tears can't heal on their own, you can often achieve good function without surgery. But, if you use your arm for sports or overhead work and you're active, then surgery is typically recommended since many tears don't heal without surgery.
How to Get A Torn Rotator Cuff Diagnosed?
To determine if your rotator cuff is torn, the doctor will perform a physical exam of your shoulder and take down the history of your injury. During the exam, they'll check your muscle strength and range of motion. They'll also see what motions cause your shoulder to hurt.
Additionally, the doctor might use:
- X-rays: X-rays help them see your humeral head (top of your arm bone) to see if it's pushing into the rotator cuff area.
- MRI: This uses a powerful magnet and radio waves to make detailed images of your shoulder.
- Ultrasound: The doctor uses this to see your muscles, tendons and bursas (soft tissues) in your shoulder.
MRI and its use for Diagnosing Rotator Cuff Tear
When it comes to an MRI and rotator cuff injury, an MRI does a better job showing the doctor soft tissues such as rotator cuff tendons. It shows the rotator cuff tear, what size it is and where it's located within your tendon. MRIs can also provide the doctor with a better idea of the age of your tear since it shows the quality of the muscles of the rotator cuff.
Rotator Cuff Surgery
The surgeon will carry out your rotator cuff surgery in an outpatient surgical setting or in a hospital using any of these following methods:
- Minimally invasive surgery: In this surgery, the surgeon inserts an arthroscope and specialized instruments through small incisions they've made in your shoulder. The arthroscope is a lighted, thin tool with a small camera that transmits images to a video screen of the inside of your body. The surgeon views these images as they perform your surgery. MIS can involve less pain and a quicker recovery than open surgery because it causes less damage to your muscle and other tissues. Also, the surgeon makes smaller incisions than those in open surgery and they thread surgical tools around your tissues rather than displacing them or cutting through them like in open surgery.
- Open surgery: The surgeon makes a big incision in your shoulder during this surgery. The surgeon can directly access and view the surgical area in open surgery. Open surgery does require a bigger incision and involves more displacement and cutting of your muscle and other tissues. It typically involves more pain and a longer recovery than MIS because it leads to more trauma to your tissues. But, it might be a more effective and safer method for certain conditions or patients.
- Mini-open surgery: The surgeon uses newer technology in this surgery and combines a smaller open procedure with a minimally invasive arthroscopic technique. The incision the surgeon makes is one to two inches long and is a smaller incision than that in a standard open surgery. This approach allows the surgeon to make more intensive repairs than they would with MIS. But, it doesn't cause as much damage as open surgery since your muscles stay attached during the surgery.
The surgeon will decide which surgery type is better for you and the length of time you'll need to stay at the surgical center or in the hospital based on your:
- Rotator cuff tear diagnosis
- Medical history
- Personal preference
- General health
Who Performs the Rotator Cuff Surgery (Orthopedic Surgeon)
An orthopedic surgeon performs rotator cuff surgery. An orthopedic surgeon specializes in the surgical treatment of conditions of the connective tissues and bones.
Rotator Cuff Surgery Recovery Time
Following surgery, you'll likely wear a sling for about four to six weeks. The doctor will probably have you do the following to help make your recovery faster:
- Remove your sling a few times each day and move your wrist, elbow and hand to help obtain better flow of blood in those areas.
- Don't lift your arm to your shoulder until you receive the OK from your doctor.
- If you experience swelling and pain in your shoulder, place some ice on it for around 20 minutes at a time.
Your recovery experience will depend on the tear's size and how long you've had the tear. The more recent and smaller the tear, the better chances you have of experiencing full-range of motion and being pain-free.
Patience is important. Recovery takes time. It could take as long as a year before you can fully use your shoulder.
Return to Work Time Following Rotator Cuff Surgery
When you're able to return to work after your rotator cuff surgery will depend a lot on the type of work you perform. If you have a sedentary job, you'll probably be able to go back to work after a week or two. Your arm will still be in a sling when you go back to work, however, it shouldn't impact you too bad as long as you aren't doing any pulling, pushing, carrying or lifting.
You can begin light-duty work that involves no lifting, pushing, pulling or carrying within four weeks after your surgery. Around three to four months after your surgery you should be able to perform waist level lifting of five to 10 pounds, shoulder level lifting around three to six months and overhead and heavy lifting between six and 12 months after surgery.
The Physical Therapist and Their Role in Rotator Cuff Surgery Recovery
Unless you suffered a severe injury, physical therapy is the usual starting point. The PT will ask you questions about the things you do and about your life. They'll perform some testing to learn more about the pain you're experiencing. They'll ask you to move your arm to the side, raise it or push against something to test your limits.
Physical therapy can help in many ways. The PT will help you:
- Learn exercises to strengthen the muscles of your shoulders
- Get your range of motion back
- Learn to safely carry objects
- Improve how you stand and sit (your posture) for helping to decrease pain
- Find ways of doing things so they won't hurt your shoulder
- Find ways to sleep that won't hurt your shoulder
- Understand the reason why you must continue moving
- Get back to your normal activities
- Use heat or ice to alleviate pain
Physical therapy can also help with recovery following rotator cuff surgery to improve movement and strength and help you get back to normal life. The PT will also show you how to avoid shoulder injury again after surgery.
How Much Does A Rotator Cuff Surgery Cost?
The doctor's office should be able to give you an estimate of the hospital fee and surgeon's fee. Several factors will determine the cost of rotator cuff surgery. However, estimates often range between $6,600 to $11,100. The best way for you to receive an accurate estimate, is to contact your insurance company. The surgery's cost will be determined based on certain variables like your:
- Insurance coverage
- Out-of-pocket maximum
- Annual deductible
The surgery's cost will usually include the surgeon's fee, lab tests, anesthesia, imaging and the hospital.
Does Insurance Cover Rotator Cuff Surgery?
Health insurance generally covers surgery. If you're insured, your out-of-pocket costs will likely consist of a hospital copay, specialist copay and coinsurance for the procedure, which can reach the annual out-of-pocket maximum.
Narcotics and Pain for Rotator Cuff Surgery
Postoperative pain management is a part of rotator cuff surgery that helps ease pain, begin your rehabilitation process quickly and reduce hospital stay. According to a study, after rotator cuff surgery, patients experienced severe postoperative pain within their first 48 hours. Opiate analgesic drugs and patient-controlled morphine injections are often used to help reduce postoperative pain.
However, when it comes to narcotics, there are some side effects, limitations and risks. Opioids can cause sedation, nausea, vomiting, intestinal ileus and constipation.
Schedule Your rotator Cuff Tear Consultation With Coastal Orthopedics
Injuries occur, but they don't have to keep you from living your life, especially when you have quality orthopedic sports medicine available.
Whether you play sports or just live an active lifestyle, here at Coastal Orthopedics, we're dedicated to returning you to this active lifestyle after an injury. Our experienced team here in our Corpus Christi orthopedic surgery practice are committed to working with you closely to maximize your ability to enjoy an active and full life.
Whether you're looking for more information on rotator cuff surgery or would like to discuss some of our other services, contact us today to schedule your consultation.