Damage to the rotator cuff is a common source of shoulder pain. Injuries, or degeneration that occurs with overuse or age, can lead to pain. Pain is usually felt about the shoulder or sometimes down the outer aspect of the arm. Use of the arm, especially reaching overhead, often makes the pain worse. Sometimes patients feel that the arm is weak and depending upon the severity of the problem may actually notice new mechanical symptoms such as popping or grinding within the shoulder. If those symptoms of pain restrict the patient’s use of the arm they may develop a secondary condition called adhesive capsulitis or “frozen shoulder” where the joint itself becomes stiff so that even with assistance from the other arm the injured shoulder won’t move.
Sometimes patients sustain a specific injury that causes a rotator cuff tear. Common injuries include strains while trying to lift a heavy object, an unexpected pull on the arm, or a fall onto the arm. Tears can be partial thickness or complete thickness. In partial thickness tears only a percentage of the tendon’s attachment to the bone is pulled away where in complete tears the entire attachment is torn away. Most commonly just one of the four rotator cuff tendons is torn, although tears to 2 or 3 tendons do also occur.
Partial tears that involve less than 50% of the tendon thickness frequently can be managed or treated effectively with a period of rest, a course of anti-inflammatory medication, physical therapy, and possibly a local cortisone injection. Those that injure more than 50% of the tendon thickness frequently cause ongoing pain as do those that are completely torn from the bone. These injuries are more likely to require surgical repair.
Rotator cuff problems can also be secondary to overuse or simple age related degenerative changes (wear and tear). It is estimated that 10% of patients over the age of 60 years will have a rotator cuff tear and that number increases to more than 30% of the patients over 80 years of age. Bone spurs can form as we age and contribute to the development of these tears.
Not all age related rotator cuff tears cause pain but for those that do as well as those that occur in patients from a distinct injury surgery becomes an option. In my practice repair is done with arthroscopic technique. Many surgeons still use a single larger incision or so called “open” technique. Both open and arthroscopic technique can work well. For me and my patients I think that the arthroscopic technique allows for better assessment of the tear in the operating room due to better visualization than can be obtained thru even a large incision, less pain and postoperative stiffness, and better cosmetics.