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, of Boulder Center for Orthopedics during a free Boulder Community Health
Watch Dr. Seng's online lecture on "Relieving Shoulder Pain"
What is the Rotator Cuff?
The shoulder joint is made up of the upper arm bone (humerus) and the shoulder
blade (scapula). The rounded end of the humerus moves inside a shallow
socket in the scapula.
The rotator cuff is a group of muscles and tendons that form a covering
around the head of the humerus. The rotator cuff attaches the humerus
to the scapula 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 provide 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
an x-ray, ultrasound, arthroscopy, CT arthrogram 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
Since there are a wide range of treatments for most rotator cuff tears,
Dr. Seng said you'll want to understand your options before you make
a decision. To help with the decision, here are questions he suggested
you ask your provider:
- Do I need surgery or injections?
- What if I just leave it alone?
- Do I have a partial, half, one-quarter or full thickness tear?
- How severe is it?
- What are common surgical and non-surgical strategies and interventions?
- What are the expected outcomes of these treatment options?
- Will you be treating the pain or dysfunction?
- What would you do if this were your shoulder?
A Single Assessment Numerical Evaluation, or S.A.N.E score, is often used
to understand what level of pain a patient is experiencing. Dr. Seng suggests,
“Discussing your S.A.N.E. score with your provider can help you
decide on the best treatment. You'll also want to consider your personal
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 or with injections, including steroids, platelet
rich plasma, prolotherapy and stem cells.
Surgical Treatment Innovations
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.
Arthroscopy is currently the gold standard for rotator cuff repair. This
procedure requires one or two very small incisions to allow for the insertion
of a tiny camera. A surgeon then uses specially designed instruments to
repair the tear.
Dr. Seng then described several surgical innovations that have grown in
popularity at an astonishingly rapid rate:
Arthroscopic superior capsular reconstruction allows surgeons to put a “patch” on a tear that is irreparable.
“This new minimally invasive option,” said Dr. Seng, “is
a great pain-relieving procedure.”
Reverse total shoulder replacement as explained by Dr. Seng, “Is done in an arthritic shoulder that
has a large rotator cuff tear, when the muscles no longer function.”
The major difference between a standard shoulder replacement and a reverse
total shoulder replacement is the ball and socket implants of the shoulder
joint switch sides. As a result, the deltoid muscle, instead of the rotator
cuff, will power and position the arm. Dr. Seng explained, “This
type of shoulder replacement is very successful and requires minimal time
InSpace balloons is still in the trial phase and not available to the public. This procedure
uses a balloon spacer that fits between the shoulder’s scapula and
the humerus to relieve pain in cases where a patient is having a bone-on-bone issue.
Khemarin Seng, MD, has more than 15 years experience in successfully treating shoulder problems.
To schedule an appointment, call (303) 449-2730.
View/download a PDF of slides shown during Dr. Seng’s lecture on “Relieving Shoulder
Pain: Treatment Innovations for Rotator Cuff Injuries.”
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