Dr. Meredith Mayo: 'Shoulder Pain? A Rotator Cuff Tear Could Be the Problem.'

Rotator cuff tears are very common. About 17 million people in the U.S. every year experience a rotator cuff tear.

“In fact, by the time you reach 65 years old, there’s a 50% 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,” said orthopedic surgeon Meredith Mayo, MD, of BoulderCentre for Orthopedics & Spine during a free online health lecture.”

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VIDEO: Watch "Relieving Shoulder Pain"

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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,” said Dr. Mayo.

When one or more of the rotator cuff tendons becomes torn, the tendon is no longer fully attached to the head of the humerus.

She further 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. An accident such as falling on your arm or lifting something heavier than you should can cause immediate tearing.”

There are different types of tears.

• Partial tear. This type of tear is also called an incomplete tear. It damages the tendon, but does not completely sever it.
• Full-thickness tear. This type of tear is also called a complete tear. It separates all of the tendon from the bone. With a full-thickness tear, there is basically a hole in the tendon.

How Do You Know When It’s a Rotator Cuff Tear?

Traumatic Injury Tear

If a rotator cuff tear happens after an injury, symptoms can occur immediately.

“You may have fallen on an outstretched arm. This could as easily happen while walking the dog, falling off a ladder, or lifting a heavy object overhead, causing a loss of active shoulder motion. When you fell, you may have heard a pop—this is a major red flag,” said Dr. Mayo.

Tears that happen suddenly, such as from a fall, usually cause:

• intense pain
• a snapping sensation
• immediate weakness in your upper arm.

Chronic Rotator Cuff Tear

If the tear happens gradually, then symptoms tend to get worse over time. Dr. Mayo stated, “You’ll experience a slow onset of pain with loss of strength. It may become more painful to reach in the back of the car or to get a plate from the cabinet.” Other symptoms include:

• Pain when lifting and lowering your arm or with specific movements
• Arm weakness
• Pain at rest and no longer goes away with over-the-counter medications
• Pain at night. This may start to cause sleep issues.
• Difficulty with daily activities. You’ll start to notice simple things like combing their hair and dressing has become difficult.

Evaluating Your Treatment Options

While tears sometimes require surgery, a physician might suggest a wait-and-see approach or prescribe nonsurgical treatment.

Dr. Mayo noted, “If you have less than 50% tearing, we can often manage this conservatively. Additionally, conservative treatment is prescribed for those older than 65 who have chronic tears where they may never have had an injury but are experiencing ongoing pain.” Non-surgical treatments include:

• Non-steroidal anti-inflammatory (NSAIDs) medicines such as ibuprofen.
• Physical Therapy (PT) as a home program or formal sessions with a therapist that can include massage and/or stimulation.
• Activity modification may be recommended to reduce impact on the shoulder.
• Steroid injections are the last course of action. “They’re reserved to get people through severe pain, allow them to sleep and get through their PT treatments,” she said.

Surgical Treatment Innovations

Dr. Mayo 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. Mayo said.

Arthroscopy is currently the gold standard for rotator cuff repair. This procedure requires very small incisions to allow for the insertion of a tiny camera. A surgeon then uses specially designed instruments to repair the tear.

Dr. Mayo then described several surgical innovations that have grown in popularity:

• Arthroscopic superior capsular reconstruction - allows surgeons to put a “patch” on a tear that is irreparable. “This new minimally invasive option,” said Dr. Mayo, “is a great pain-relieving procedure. For this procedure we use non-human tissue from an animal to recreate the rotator cuff “shower cap” and to improve shoulder biomechanics. This makes up for our rotator cuff not being able to be attached.”
• Reverse total shoulder replacement – performed on an arthritic shoulder that has a large rotator cuff tear and when the muscles no longer function. “In this surgery,” explained Dr. Mayo, “we put the ball on the socket side, and the socket on the ball side. This compensates for a patient having a deficient rotator cuff. As a result, the deltoid muscle, instead of the rotator cuff, will power and position the arm.”

Click here to view/download a PDF of slides shown during this lecture.

Please call 303-449-2730 to schedule an appointment with Meredith Mayo, MD.