So many times we hear about Rotator Cuff Tears or injuries. The term has become so common that nearly everyone that suffers a shoulder injury or shoulder pain becomes concerned; "Did I tear my Rotator Cuff?" But, most people really do not know what that is, exactly. It has just become commonplace to presume it will require surgery. Well, that is not necessarily,the case at all times.
First, let's be clear about what rotator cuff is. The rotator cuff is a group of tendons that attach to the long bone in the shoulder (humerus). It is responsible for the dynamic stabilization of the joint by keeping the humerus bone against (and in line with) the socket bone (glenoid). This group of tendons also function by moving the arm in various directions.
Rotator Cuff disease can be a wide range of conditions. When trauma is not involved, rotator cuff pain can be the result of impingement, which is essentially the pinching and scraping of the tendons by bone spurs (overgrowth of bone) above. So, when the arm is raised, the tendons endure the bone spur digging into the tendons. This often causes pain and inflammation which is essentially the first stage of rotator cuff disease. The subsequent stages involve progressive damage to the tendons and eventually, the rotator cuff may tear. This is more common in an older population and often can be treated without surgery.
Physical therapy and anti-inflammatory medication is usually the first line of treatment for nearly all stages of this type of Rotator Cuff disease. If not improved then a cortisone injection may give some relief and ultimately, if symptoms do not improve, then Arthroscopic Surgery is warranted. If there is no full tear, then the bone spurs and inflammation are removed. If a complete tear is present then a repair is then performed.
Traumatic tear of the Rotator Cuff is a different condition in which an actual traumatic event causes one or more of the tendons to tear off their attachment to the bone. This is seen in younger patients and can occur as innocently as suddenly grabbing on to the railing when tripping on the stairs. Of course, a fall or other high trauma (such a motor vehicle accident) can cause a tear. A high level trauma can even cause the shoulder to dislocate which can result in a significant tear of the rotator cuff tendons. These types of Rotator Cuff Tears need to be repaired. Often, if they are not repaired then the torn tendons retract and atrophy causing increased weakness. If the tendons are too retracted and atrophied then it may be too late to repair. Therefore, it is very important to consult with an orthopedic surgeon immediately if trauma to the shoulder occurs.
Lastly, throwing athletes may suffer tears to the rotator cuff. This may be a result of recurrent wear and tear, instability in the joint, or extreme force of the motion. Typically partial tears occur in this case and sometimes rehabilitation may alleviate symptoms. If a complete tear occurs in an athlete, then Arthroscopic Surgery to repair the tendons is very important because of the young age of the patient, so to prevent retraction and subsequent, advanced disease to the joint.
Thus, Rotator Cuff tears are not all the same, nor are the patients. This is why it is important to consult with an orthopedic surgeon that is experienced and skilled in treatment of the Rotator Cuff.
- Leon E. Popovitz, MD
New York Bone and Joint Specialists is a top rated, private Orthopedic and Sports Medicine practice in with locations in New York City, Hoboken and Englewood, NJ. The Orthopedic Surgery, Physical Medicine & Rehabilitation, and Pain Management specialists routinely perform surgical and non-surgical treatments for professional athletes from across the United States and various other countries.
Dr. Leon Popovitz and Dr. Michael Mizhiritsky, along with their team of best in class orthopedic physicians, are known for their exemplary orthopedic surgical skill and best rated physical medicine and rehabilitation program. This, along with their top in-office physical therapy and long-term sports rehabilitation processes, leads to athletes of all levels returning to their top physical potential. Contact us today to schedule a consult!