Whether or not a patient requires surgery after being diagnosed with a rotator cuff tear is a common discussion at the clinic. Just like with most injuries, not all rotator cuff tears are created equal. Before the decision to go in for surgery is made, there are a few factors to be considered: size of the tear, location of the tear, how it started (i.e. gradual onset or after a fall or accident) and how long rotator cuff symptoms have been present.
Symptoms of a rotator cuff injury often include: weakness during overhead activities (i.e. combing hair, reaching to the side), snapping or cracking when moving the arm, stiffness and pain at night, difficulty lying on the shoulder, and pain referred to the outside of the shoulder.
Anatomy of the Rotator Cuff
The rotator cuff provides stability to the shoulder, which is predisposed to dislocations due to its shallow socket. A group of tendons and muscles in the shoulder, the rotator cuff connects the humerus (upper arm) and scapula (shoulder blades). The rotator cuff muscles and tendons keep the humeral head ball in the socket of the scapula during all movement, with the help of the surrounding ligaments. The muscles that make up the rotator cuff are a group of four muscles that work together to lift and rotate the arm: the supraspinatus, infraspinatus, teres minor and subscapularis.
Rotator Cuff Tears
Most commonly, tears occur in the supraspinatus tendon where it attaches on the humeral head. Larger tears can include the infraspinatus, teres minor and subscapularis tendons. A major difference in these tears is whether they are partial or full thickness tears.
Treating full thickness tears with physical therapy is often less successful, especially if the tear occurred abruptly. In the case of a sudden fall or injury, certain studies suggest that surgery is often more successful as compared to physical therapy. If you have experienced a gradual onset of symptoms, you have a higher likelihood of responding to physical therapy.
Other factors that determine whether surgery is necessary really depend on the patient’s individual situation and goals. In the cases of athletes, carpenters, or anyone who engages in repetitive activities (especially above shoulder height), higher demands are placed than those of sedentary individuals.
A proper diagnosis is essential to ensure the repair of a rotator cuff. In certain cases, the rotator cuff tendon and muscles can shorten if surgery is delayed, which makes it more difficult or even impossible to repair. This diagnosis can only be done with a magnetic resonance imaging (MRI) and a consultation with an orthopedic surgeon.
At times, a neck injury can appear like a rotator cuff tear or tendinitis, so a proper examination of both the shoulder and the neck is essential. In the case of a trauma (i.e. a fall or motor vehicle accident), both the neck and the shoulder can be sources of pain, which is not always clear to the patient or healthcare practitioner in the early stages. In an effort to compensate for the shoulder weakness or pain, patients will shrug to elevate the arm using the muscles of the neck, which may lead to a compensation injury.
Conservative Treatment for Rotator Cuff Injury
If you choose to pursue conservative treatment as opposed to surgery for your rotator cuff injury, care will typically include the following approaches:
1. Rest – Avoid participating in certain activities that delay healing.
2. Nonsteroidal anti-inflammatory drugs (NSAIDs) – Medications like Ibuprofen and Naproxen can reduce pain and swelling.
3. Physical Therapy – Combinations of exercises to increase range of motion and strengthening of the shoulder and neck, in conjunction with instructions on correct posture and proper movement patterns, will facilitate the healing of a rotator cuff injury.
4. Injections – Several types of injections can be used with varying degrees of success and possible side effects. They range from homeopathic traumeel injections, platelet rich plasma (PRP), hyaluronan injections, and/or steroid injections depending on your surgeon’s preference or experience.
As in any case of deciding if surgery is indicated, discuss your situation with your physical therapist and orthopedic surgeon to understand all of your options for the best possible outcome.
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Apex Orthopedic Rehabilitation in Paramus, NJ provides orthopedic and sports physical therapy services for the greater Ridgewood, Paramus, and Bergen County region. This blog is intended for informational purposes only and should not be used for diagnostic or prescriptive purposes. The views expressed here are the author’s views and should be taken as suggestions. Always consult your doctor or healthcare practitioner before engaging in a physical therapy or rehabilitative program.