From conservative treatment options to more advanced surgical techniques (rotator cuff repair)
*Credit Honor Health, featuring Dr. Harmsen
Shoulder pain that increases with motion, awakens one from sleep or is associated with weakness may be a sign of a torn rotator cuff. Whether the pain is caused by a sudden injury or develops gradually over time, treatment options for a rotator cuff tear are available at HonorHealth and can effectively reduce discomfort, improve range of motion and build shoulder strength.
Degenerative wear and tear
The rotator cuff is made up of four muscles that attach and create a cuff around the ball of the ball and socket joint of the shoulder. This cuff helps stabilize the ball and socket joint, allowing one to lift and rotate the arm.
A rotator cuff tear is a common cause of pain and disability, accounting for almost 2 million people in the United States who went to their doctor in 2013 because of a rotator cuff problem, according to the American Academy of Orthopaedic Surgeons.
“As we get older, we naturally experience some extent of rotator cuff wear and tear, which often occurs slowly, usually by age 60,” said Samuel Harmsen, M.D., an orthopedic surgeon and shoulder and elbow specialist at HonorHealth Greenbaum Surgical Specialty Hospital. “A rotator cuff tear is generally more prevalent in those who are active, but can also be attributed to family history, age, arthritis, or even smoking.”
Although not all individuals with rotator cuff tears develop symptoms, many experience shoulder pain, irritation, inflammation and weakness, which can be very debilitating.
“Patients often experience pain with activities such as throwing, lifting or lowering the arm, or even simple tasks such as putting the dishes away,” Harmsen said. “Night pain that awakens one from sleep is also very common.”
Treatment typically begins with a more conservative approach and may include a combination of physical therapy, activity modification, over-the-counter pain medication and steroid injections to alleviate pain and improve function.
“Our goal is to manage symptoms, increase function and stabilize the shoulder joint to improve quality of life,” Harmsen explained.
In about 80 percent of patients, nonsurgical treatment relieves pain and improves function in the shoulder, according to the American Academy of Orthopaedic Surgeons.
“When conservative management is no longer successful, surgery would be the next recommended step,” Harmsen added.
A rotator cuff tear can also occur suddenly, while playing sports, lifting too much weight or after a bad fall. If the tear occurs with an injury, individuals may experience acute pain, a snapping sensation, and immediate weakness of the arm, according to the American Academy of Orthopaedic Surgeons.
“While an acute rotator cuff tear can happen to anyone, most injuries occur in younger and more active patients,” Harmsen explained. “Injuries are often associated with strenuous activities that cause a sudden pull or stress to the shoulder. Shoulder dislocations can also result in acute rotator cuff injuries in older patients.”
Experts say that if a rotator cuff tear is not treated, it could be more difficult to repair over time and symptoms may worsen. Depending on the timing of the injury, size and shape of the tear, a person’s age, their activity level and overall health, surgical intervention may be necessary.
The orthopedic surgeons at HonorHealth have access to the latest technology and can perform both traditional and minimally invasive surgical techniques to repair a torn rotator cuff.
“Arthroscopic surgery is a more advanced approach that utilizes a small camera which allows greater visualization of the shoulder joint to better understand the nature of the tear,” Harmsen explained. “Because of this less invasive technology, we are able to make smaller incisions that result in less postoperative pain.”
Other techniques, including superior capsular reconstruction and reverse shoulder arthroplasty, are sometimes used after multiple surgical attempts have been unsuccessful, if the rotator cuff cannot be repaired or when arthritis is present. These more advanced techniques are also available at HonorHealth.
After surgery, patients often use a sling during a period of immobilization to keep their arm in a protected position, followed by physical therapy and home exercises to improve range of motion and regain strength.
“Most patients do very well with surgical intervention,” Harmsen said. “While some early stiffness is expected, the results often lead to resolution of pain and improved shoulder function.”
Experts say it takes approximately 12 weeks to heal before patients can return to activities of daily living.
“Improvements to overall shoulder health, pain and function can continue for up to a year after surgery,” Harmsen added.
Learn more about rotator cuff treatment options at HonorHealth.
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