Rotator cuff tears can happen at any age but are more likely to happen
as we get older.
“In fact, by the time you reach 60 years old, there’s a good
chance you’ll have some partial or complete rotator cuff tears.
These tears can limit movement and, for many people, cause serious shoulder
pain that affects work, play and sleep,” orthopedic surgeon
Khemarin Seng, MD, told a crowd of nearly 175 people during a free health lecture held on
Aug. 22 in Boulder.
The rotator cuff is a group of muscles and tendons that form a covering
around the head of your upper arm bone (humerus). The rotator cuff attaches
the humerus to the shoulder blade and helps you lift and rotate your arm.
“When one or more of the rotator cuff tendons becomes torn, the tendon
is no longer fully attached to the head of the humerus,” Dr. Seng
explained. “Rotator cuff tendons can wear down with age, leading
to tears. Overuse from everyday activities or exercise — for example,
doing yard work or playing tennis — can also cause this injury.
So can an accident such as falling on your arm or lifting something heavier
than you should.”
How Do You Know When It’s a Tear?
If a rotator cuff tear happens after an injury, symptoms can occur immediately.
If the tear happens gradually, then symptoms tend to get worse over time.
“However, not all rotator cuff tears cause pain. About 40 percent
of them have no symptoms and can go unnoticed,” Dr. Seng stated.
“Only a visit to a physician can give you an accurate diagnosis
of a rotator cuff tear. But there are symptoms to be aware of."
Symptoms of a rotator cuff tear include:
- a dull achy pain deep in the shoulder
- pain or tenderness when reaching overhead
- pain in the front of the shoulder that radiates down the side of your arm
- weakness in your arm
- difficulty sleeping on the injured shoulder
- difficulty getting a full range of shoulder motion
- a locking or catching sensation in your shoulder
“The diagnostic process for rotator cuff tears typically starts
with a patient interview and history. I’ll ask when and where you
have your pain, what your occupation is, the sports you engage in and
whether you’ve experienced trauma in your shoulder,” Dr. Seng said.
After the interview, Dr. Seng performs a physical examination to assess
the rotator cuff. He will test your posture, muscle development and the
shoulder joint, particularly the front, which is commonly affected. “I’ll
then test the rotator cuff muscles in isolation, and perform some provocative
tests, which can frequently isolate rotator cuff tears,” he said.
If a rotator cuff tear is suspected, he may order imaging tests such as
x-ray, ultrasound, arthroscopy, CT arthrograms or MRI.
“MRI has been the gold standard for diagnosing rotator cuff injuries
because it provides an amazingly detailed and accurate cross-sectional
view of the shoulder, showing both complete and partial rotator cuff tears,”
according to Dr. Seng. “Yet recent studies have indicated that ultrasound
and MRI are comparable in both sensitivity and specificity, which is why
ultrasound is gaining more acceptance in the U.S. for diagnosing tears.”
Evaluating Your Treatment Options
While tears sometimes require surgery, a physician might suggest a wait-and-see
approach or prescribe nonsurgical treatment. Some tears can be treated
with physical therapy, anti-inflammatory medication, a sling or brace
to limit shoulder movement and injections, including steroids, platelet
rich plasma, prolotherapy and stem cells.
“Since there is a wide range of treatments for most rotator cuff
tears, you'll want to understand your options before you make a decision,”
Dr. Seng advised. To help with the decision, here are questions he suggested
you ask your provider:
When Is It Time for Surgery?
- Do I have a partial or full thickness tear?
- How severe is it?
- What are the expected outcomes of my treatment options?
- What would you do if this were your shoulder?
Dr. Seng said rotator cuff surgery is often the best option when sudden
weakness and pain follows a shoulder injury or when non-surgical treatments
are no longer helpful.
There are different approaches to surgery, depending upon whether it’s
a partial or complete tear. “A partial tear may need only a smoothing
procedure to even out the roughness from the tear. A complete tear is
fixed by re-attaching the tendon back to its original site on the humerus,”
Dr. Seng said.
Khemarin Seng, MD, has more than 15 years experience in successfully treating shoulder problems.
To schedule an appointment, call (303) 449-2730.
Click here to view PowerPoint slides from Dr. Seng’s lecture on “Relieving
Shoulder Pain: Treatment Innovations for Rotator Cuff Injuries.”
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