Basics of Rotator Cuff Injuries

One of the most frequent musculoskeletal injuries is the rotator cuff injury. Sometimes this type of injury is not associated with symptoms, but usually it is quite painful. A rotator cuff tear or rotator cuff tendonitis can cause you to experience pain and weakness in the shoulder when using your arms. It can be especially painful to lift the arm higher than shoulder level. Luckily, there are a number of ways to treat rotator cuff injuries - both surgical and non-surgical. The type of injury you have, your condition, and your age will be determining factors in deciding which type of treatment is right in your situation.

There are two categories of rotator cuff injury. One is rotator cuff tendonitis. The other is rotator cuff tear. Be aware that there are several other conditions that could be the cause of shoulder pain. The only way to get an accurate diagnosis of rotator cuff injury is to see a doctor. He or she will first look at the symptoms and perform a basic physical examination. After this, the physician may use a local anesthetic that will be injected into the injured shoulder. This will help determine whether the injury is a muscle tear or tendonitis. If the injury seems to be a rotator cuff tear, the doctor may order some imaging tests. These will help confirm that the injury is a tear and isolate the location of the injury.

It is far more common for the diagnosis to be rotator cuff tendonitis; however, the treatment for tears is very similar to the treatment for tendonitis. Both can be treated conservatively with what is known as RICE therapy. That is: rest, ice, compression, and elevation. You may also want to use an over-the-counter pain medication like ibuprofen. Additionally, your doctor may give you a referral to a physical therapist to learn how to modify your movements and to get a list of exercises that may be beneficial to you. If your tendonitis pain persists, your doctor may give you injections of a steroid/anesthetic mixture. These would be administered to the joint to relieve pain.

About half the patients using this kind of non-surgical treatment experience an increase in ROM (range of motion) and a decrease of pain within 2 or 3 months. This kind of treatment has several advantages. First of all, non-invasive treatment avoids surgical risks such as infection, anesthesia complications, and permanent stiffness. Second, there is no recovery time involved. Of course, there is also a downside in that this route could lead to an increase in the size of the tear. Additionally, the patients activity level may be decreased during the healing period. And, there is the risk that a non-invasive method may simply not work. If this is the case, and the non-invasive option fails, then surgery may be the alternative. The doctor may also decide that surgery is the better option if he or she feels that the injury is severe enough to merit it as the first option.

Click here for more on rotator cuff surgery .

When rotator cuff injury is treated with surgery, there are generally three options.

The first way is open repair surgery. When open repair surgery is chosen, the surgeon will make a full incision into the shoulder. This large incision has the potential of leaving a large scar; however, this method allows the surgeon to have a great deal of freedom of movement.

The second method is mini-open repair surgery. While this method is similar to open repair surgery, it differs somewhat in that it utilizes arthroscopy. The use of arthroscopy allows the surgeon to make a smaller incision, leaving a smaller scar. This method is an outpatient procedure.

The third method is known as all arthroscopic surgery. This is the simplest option in that it is an outpatient procedure, and it also leaves the smallest scar.

The doctor will determine which procedure will work best based on the specific injury.

After rotator cuff surgery, most patients have decreased pain and an increase in range-of-motion. Recovery is usually complete within 4 to 6 months. Results are usually quite satisfactory, with 80 - 95% of patients reporting good results.

The expertise of the surgeon is a very important factor in the successful outcome of the surgery. However, there are some variables to keep in mind when considering speed and success of recovery. Among them are the type of tear, tissue quality, the patients age, and the amount the patient complies with the doctors instructions.

It is rare to experience complications with rotator cuff surgery. Tendon re-tear, which is the most commonly experienced complication, only occurs in about 6% of patients. One or two percent may have nerve injury. As little as one percent of patients may contract infection. Detachment of the deltoid muscle and/or stiffness are experienced by fewer than one percent of patients.

Dr. Edelson is a Board Certified Orthopaedic Surgeon specializing in sports medicine. His clinic, Sports Medicine Oregon, focuses on athletes of all ages. Click here to learn more about Dr. Edelson, Oregon Shoulder Stabilization Surgery and Oregon Athletic Surgery.