Shoulder pain is a very common ailment in the American population. Up to a third of people in the United States experience shoulder pain, and rotator cuff tears are one of the most common sources of that pain.
The rotator cuff is a group of muscles and tendons that hold the shoulder and help it to move in many directions. The shoulder is the most mobile joint in the body, but its ability to move comes at the cost of stability.
Surgical repair of the rotator cuff is a frequently performed procedure. According to a 2014 study published in BMC Musculoskeletal Disorders, rotator cuff repair surgeries top 272,000 per year in the United States. However, not every torn rotator cuff needs surgery. Many of my patients return to full shoulder function with more conservative treatments.
Let’s take a look at when surgery for a torn rotator cuff might be necessary, and when you can avoid it.
The shoulder is a complex joint. It has to be—just think of all the ways your arm can move: up and down, side to side, straight out, overhead, in circles. The arm needs a very mobile joint, and that’s what it gets with the shoulder.
There are three main bones in the shoulder: the scapula (shoulder blade), clavicle (collarbone) and humerus (upper arm bone). The head of the humerus fits into a depression in the scapula known as the glenoid.
Part of the rotator cuff’s job is to keep the humerus in the glenoid. It also serves to help move the arm through many planes of movement. The rotator cuff is a group of four muscles and their tendons (tendons are tough bands of tissue that attach muscles to bone). They are:
- Subscapularis (most commonly torn tendon in the rotator cuff)
- Teres minor
Together, these muscles secure the head of the humerus in the glenoid and allow the arm to be raised and moved around.
Who Needs Rotator Cuff Surgery?
Surgery to repair a torn rotator cuff is safe and effective, but not everyone needs it. My colleagues at Summit Medical Group and I prefer to follow a conservative philosophy, meaning we don’t operate unless you’re out of options.
Sometimes surgery is going to be necessary. For example, if an older patient comes to me with persistent, long-term shoulder pain and is barely able to lift his or her arm, there’s a higher likelihood that I’m going to recommend surgery.
Imaging studies—such as the magnetic resonance imaging (MRI) scans or ultrasound we use to diagnose torn rotator cuffs—will also inform my recommendation. If I see a large tear or a very severe tear, I’m more likely to recommend surgery than if the MRI showed a smaller, less severe tear.
Younger, active people who are generally in good health, eat well and get enough exercise are more prone to responding well to nonoperative rotator cuff treatment.
Nonsurgical Treatment Options
Nonsurgical treatment of a rotator cuff tear improves symptoms and shoulder function about 80 percent of the time. That means there’s a good chance that you won’t need surgery.
When someone comes to see me about a rotator cuff tear, the first thing I recommend is resting and icing the joint. This will cut down on swelling, reduce pain and decrease the chance that they’ll reinjure their shoulder or make the current tear worse.
If you already have a rotator cuff injury, I usually recommend physical therapy. Initially, physical therapy will be focused on improving range of motion and decreasing pain. Eventually, however, you’ll be doing progressively more challenging exercises designed to keep your shoulders strong and safe.
Sometimes, a corticosteroid injection can be helpful. Corticosteroids are powerful anti-inflammatory drugs injected into an area of pain. They can alleviate symptoms for weeks or even months. However, they’re not always effective for rotator cuff tears since any inflammation of the tendon is accompanied by structural damage.
Deciding to Have Surgery
Only after my patients have tried all other methods of treatment without success will I recommend surgery. Severe tears to a tendon might cause me to suggest surgery earlier, especially if the rest of the shoulder is healthy.
The goal of most rotator cuff surgeries is to either reattach the tendon to the bone or stitch a torn tendon back together. Depending on the nature and severity of the tear, the surgery can be performed as an open procedure or as an arthroscopic procedure. With an arthroscopic approach, there is a comparatively smaller incision, small tools and a flexible camera attached to a video monitor.
Rehabilitation and physical therapy will be essential to the recovery process after the surgery. Most people return to normal function in four to six months, though some tears can take even longer to heal.
If you have shoulder pain and think you might have torn your rotator cuff, request an appointment with me or one of my colleagues. We have performed hundreds of rotator cuff repair surgeries and helped even more people get rid of their shoulder pain without surgery. I’m happy to discuss your options for treatment and come up with a plan you’re comfortable with.