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Shoulder pain can be debilitating. Not only are you dealing with the constant pain, but it can limit you from performing typical everyday tasks, especially those involving lifting. But is it just pain due to aging or overuse? Or is the injury a bit more serious, like a rotator cuff tear?
Here are the facts on rotator cuff tears to help you determine if it’s time to stop putting up with the pain and take a trip to the doctor’s office.
What is a rotator cuff?
“Your rotator cuff is comprised of four tendons and muscles that connect to the upper arm,” said Dr. Peter Wang, a Lansdale Hospital orthopaedic surgeon. These tendons and muscles form a “cuff” that holds your arm in place, as well as allowing it to move in different directions.
What happens when a rotator cuff tears?
This injury happens when one of the tendons in the cuff tears, and it can occur in two ways: suddenly or over time.
“One cause is acute trauma, such as someone falling on their outstretched arm or lifting something heavy. The other way it tears is [that] the tissues tear over time. General overuse can cause tears and develops over time,” Dr. Wang explained.
When this injury occurs, if it’s sudden, you’ll experience pain right away in the shoulder and arm. If this injury develops over time, you may feel a dull ache deep in your shoulder. You may also feel weakness and tenderness in your shoulder and have difficulty moving your shoulder, especially when trying to lift your arm above your head.
“One would typically experience pain with any attempt to reach forward or overhead or any attempt to move the arm away from the body,” Dr. Wang said.
A rotator cuff tear may also make sleeping on the side of the injury painful or difficult.
Who is at risk?
According to Dr. Wang, there are two main groups that tend to suffer from a rotator cuff tear.
The first age group tends to include younger athletes, such as baseball pitchers in their 20s and 30s. These athletes, as well as tennis players and swimmers, have a greater risk of having a rotator cuff injury from the repetitive arm motion of their sport.
The other group is at risk due to their age.
“As patients get into their fourth or fifth decade of life, they are prone to tears. The reason is that the rotator cuff is a type of tissue that doesn’t tend to age well. As we age, it loses elasticity,” he said.
The best way to prevent the injury is exercise.
“[People should] exercise on a regular basis to keep the muscles around the shoulder strong,” Dr. Wang suggested.
Do you need surgery?
Not all rotator cuff tears are created equal – some may require surgery to repair while others may not.
“Once a tear is confirmed, the treatment is based on how much that tear impacts the patient’s life. There are plenty of people who don’t know they have a tear and a lot of time those patients are able to tolerate the injury,” Dr. Wang explained.
When surgery isn’t necessary, patients can live with the injury, using pain relievers, anti-inflammatories and possibly cortisone shots to manage the pain. They may also engage in physical therapy to strengthen and improve mobility and flexibility in that arm.
When it comes to a more serious tear, patients may opt for physical therapy for a while, but if that doesn’t improve their pain, surgery may be necessary, Dr. Wang stated.
What does surgery involve?
There are two main surgical procedures orthopedic surgeons perform to repair rotator cuff injuries.
One is the traditional open surgical repair, which involves the surgeon making an incision and reattaching the tendon to the bone.
The repair can also be made via an arthroscopic surgery – a small camera is inserted into the patient’s shoulder for the doctor to see and repair the tear.
“The advantage [of arthroscopic surgery] is there’s less pain involved,” Dr. Wang said.
This surgery is typical performed as an outpatient procedure, so a hospital stay isn’t required. Following surgery, Dr. Wang stated that it takes most patients about six months to sufficiently recover and get back to the way they were before the injury.