The rotator cuff helps to lift and rotate the arm and to stabilize the ball of the shoulder within the joint.
If the tear occurs with injury you may experience acute pain, a snapping sensation, and immediate weakness of the arm.
A rotator cuff tear can extend or get larger over time. This can occur with repetitive use or a re-injury. It is common for patients with known rotator cuff disease to have acute pain and weakness following a minor injury. This likely represents extension of an existing tear.
If you know you have a rotator cuff tear, then worsening pain and decreasing strength may mean the tear is getting larger.
If you have injured your shoulder or have chronic shoulder and arm pain, it is best to see your orthopedic surgeon. He or she can then make a diagnosis and begin treatment. The doctor may recommend a diagnostic study such as MRI (magnetic resonance imaging) to confirm the diagnosis.
Early diagnosis and treatment of a rotator cuff tear may prevent symptoms such as loss of strength and loss of motion from setting in.
If your primary physician has already made the diagnosis, an orthopaedic surgeon can review both surgical and nonsurgical options and start treatment.
Many rotator cuff tears can initially be treated nonsurgically. Anti-inflammatory medication, steroid injections, and physical therapy may all be of benefit in treating symptoms of a cuff tear. The goals of treatment are to relieve pain and restore strength to the involved shoulder.
Even though tears cannot heal on their own, satisfactory function can sometimes be achieved without surgery. Patients must understand that an unrepaired rotator cuff tear will never heal. These tears get worse over time. Small tears progress slowly and larger tears will worsen more quickly over time. Eventually the tendon may be so badly torn and retracted that it cannot be repaired at all. This can be a major functional impairment in a younger more active patient, and a source of pain and inconvenience for older patients with fewer physical demands
If, however, you are active and use your arm for overhead work or sports, then surgery is most often recommended because many tears will not heal without surgery.
Surgery is recommended if you have persistent pain or weakness in your shoulder that does not improve with nonsurgical treatment. Frequently, patients who require surgery will report pain at night and difficulty using the arm for lifting and reaching. Many will report ongoing symptoms despite several months of medication and limited use of the arm.
Surgery is also indicated in active individuals who use the arm for overhead work or sports. Pitchers, swimmers, and tennis players are common examples.
The type of repair performed is based on the findings at surgery. A partial tear may require only a trimming or smoothing procedure called a débridement. Whether a partial tear requires a repair or a débridement will depend on the degree or the tear. A full-thickness tear within the substance of the tendon can be repaired side to side. If the tendon is torn from its insertion on the humerus, it is repaired directly to bone.
Dr Mazzara can recommend which technique is best for you. In all circumstances, the tendon heals to the bone in 6 weeks. In my opinion, arthroscopic repair may not be best for every tendon tear, especially those that
Rehabilitation plays a critical role in both the nonsurgical and surgical treatment of a rotator cuff tear.
When a tear occurs, there is frequently atrophy of the muscles around the arm and loss of motion of the shoulder. An exercise or physical therapy program is necessary to regain strength and improve function in the shoulder.
Even though surgery repairs the defect in the tendon, the muscles around the arm remain weak, and a strong effort at rehabilitation is necessary for the procedure to succeed. Complete rehabilitation after surgery may take several months.
Dr Mazzara can prescribe an appropriate program based on your needs and the findings at surgery.