Rotator Cuff Tears: More Common Than You Think (Part 2)

A partial or complete rotator cuff tear is a common athletic injury as well as an occupational hazard in jobs requiring overhead lifting or similar repetitive movements. However, as we learned in last month’s column, the number one risk factor is the natural wear and tear of age, especially in people over age 60. Counting all these factors, more than two million Americans seek medical help each year for a rotator cuff problem.

In this article, I’ll discuss what comes next if your doctor has determined (through physical exam, X-ray, and/or MRI) that you have a partial or complete tear in a rotator cuff tendon.

Unless the tear or injury is severe, your doctor may start with a more conservative, non-surgical treatment option such as physical therapy. The good news is that physical therapy is often as effective as surgery in getting back your range of motion, easing the pain and helping you return to your regular activities. Physical therapy can also help prevent future injury through stretching and strengthening exercises especially targeted to the shoulder.

If your shoulder shows no improvement after six to 12 weeks, you may need surgery to relieve your pain and restore function. Depending on the type and severity of the tear, your surgeon has two options:

• Arthroscopic surgery, typically an outpatient procedure, in which the surgeon, with the help of a tiny camera, can make the needed repairs through thin tools inserted into the shoulder.
• Open surgery, in which the surgeon makes an incision in your shoulder, detaches the shoulder muscle, and makes the needed repair in the tendon. Open surgery, like arthroscopic surgery, does not typically require an overnight stay in the hospital.

Both types of surgery can be done under general anesthesia or by use of a nerve block which numbs the shoulder and arm while you stay awake. Recovery from arthroscopic is usually quicker than if you have open surgery, but time is a big factor in both.

You will probably be in a sling for about four to six weeks. No driving for a week or two. The pain will be around for a while, even a few months, before you feel better.

To lessen the risk of opioid addiction, your doctor will recommend over-the-counter pain relief medications such as acetaminophen, aspirin, ibuprofen, or naproxen. If opioids are needed, take only as directed and stop using them when your pain is tolerable.

Your doctor will give you at-home strengthening exercises to do and likely also prescribe a round or two of physical therapy. Recovery from rotator cuff surgery does take patience and perseverance, but keep in mind, most people are back to normal in three to four months.

How can you keep your shoulders healthy and avoid rotator cuff tears?

With acute tears, the kind from a sports injury or the result of a fall or other accident, the focus will be on rehabilitation starting with physical therapy and then a home and work regimen that limits heavy lifting for a period of time. Shoulder strengthening exercises may be needed for a year or two.

Shoulder strengthening exercises, such as those using resistance bands or cables, are good and best done with your hands at your sides or at shoulder level. Avoid lifting weights such as barbells over your head.

Make adaptions to household or work tasks that require extensive lifting of the arms overhead, such as painting ceilings, or the use of heavy equipment or power tools that require overhead lifting. Prolonged repetitive movement and age are the biggest contributors to chronic tears, but in these cases, there are ways to prevent or minimize the chance of a tear occurring.

If you enjoy sports and want to keep your shoulders in shape for as long as possible, a non-load bearing activity such as swimming may be your best choice. Tennis, especially those powerful overhead serves, puts a lot of torque on the tendons, as does baseball, especially the pitching motion. Many times a patient will tell me, “but doctor, I was just playing catch with my son.”

Rotator cuff tears are common but fixable. Sports injuries and accidents may not be avoidable, but we can lessen the risk of chronic rotator cuff tears by giving our shoulders, one of the hardest working joints in the body, the first class treatment and consideration they deserve.