Dr. Richard Harrison: Rotator Cuff Tears

By  //  February 2, 2014

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MULTIDISCIPLINARY, COLLABORATIVE TEAM APPROACH KEY TO SUCCESS

ABOVE VIDEO: This video by LeeMemorialMarketing graphically illustrates the anatomic details of a rotator cuff tear and its arthroscopic repair.

BREVARD COUNTY • MELBOURNE, FLORIDA — Imagine you’re traveling on a plane, hopefully to someplace fun. As you board the plane, you reach up to place your carry-on luggage in the overhead bin. When you turn to find your seat, you notice a deep aching pain in your shoulder.

If you’re like most people, you ignore this pain for a while. But, maybe this pain lingers, and it interferes with your activities and your ability to sleep.  When you finally ask your doctor, she says you may have a rotator cuff tear.

This actually happened to my grandfather on his way home from my wedding many years ago.

ANATOMY

The shoulder is a ball-and-socket joint with three main bones: the upper arm bone (humerus), the collarbone (clavicle), and the shoulder blade (scapula). These bones are held together by muscles, tendons, ligaments, and the joint capsule.

The arrows above indicate a tear in the supraspinatus tendon of the rotator cuff.

The arrows above indicate a tear in the supraspinatus tendon of the rotator cuff.

The rotator cuff is a group of four tendons surrounding the top, front and back of the shoulder joint that keeps the ball of the arm bone seated into the socket of the shoulder blade.

The muscles attached to these tendons are used to initiate shoulder motion and to stabilize the shoulder in its wide arc of rotation. As we age, the junction between the tendon and the bone can become weaker and more prone to rupture. The tendon can peel away a little bit or completely rip from the bone and retract away from its insertion.  These rotator cuff tears often present with characteristic symptoms.

SYMPTOMS AND DIAGNOSIS

Most rotator cuff tears in patients who seek treatment from a doctor present with pain on the side of the shoulder and upper arm, which is often worse at night. The tears can cause weakness with overhead activity because the rotator cuff muscle no longer has as strong a connection to pull on the bone. The tears can also present with discomfort from prolonged overhead activity, such as changing a light bulb or reaching to put away dishes.

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Symptoms typical of rotator cuff tears include weakness and pain when reaching high overhead.

After passing through the natural phase of trying to ignore the issue, many patients present to their doctor to investigate the problem.

The diagnosis of a rotator cuff tear is often made with physical examination, x-rays, and MRI.  The examination looks for characteristic tenderness, pain and weakness while the x-rays look for abnormalities in the bone structures and positions. The MRIs are very useful for visualizing the muscle, tendon and bone relationships.

NON-SURGICAL TREATMENT MAY BE EFFECTIVE FOR SOME

Once a diagnosis of a rotator cuff tear is made, patients are not immediately wheeled into the operating room. Not all patients with rotator cuff tears need to have surgical treatment.

Some rotator cuff tears can be managed non-operatively with shoulder strengthening as an integral element of physical therapy.

Some rotator cuff tears can be managed non-operatively with shoulder strengthening as an integral element of physical therapy.

Some tears are just a small peeling of part of the tendon from the bone, which can still cause significant inflammation to the bursa, fluid-filled sacs located between the rotator cuff and the shoulder blade that cushion and lubricate the shoulder.

It is possible to improve pain and function with non-operative treatments such as corticosteroid injections and physical therapy to decrease inflammation and to strengthen supporting muscles and improve posture.

SURGICAL APPROACH

Unfortunately, in some patients a conservative, non-surgical approach doesn’t work, or the tears can be so large it’s obvious that function cannot be restored non-operatively.  At this point, surgery to repair the rotator cuff tendons may be the best option.

Specialized instrumentation and techniques are used to arthroscopically repair a rotator cuff tear.

Specialized instrumentation and techniques are used to arthroscopically repair a rotator cuff tear.

Fortunately, rotator cuff surgical techniques and technology have advanced greatly over the past two decades.

Rotator cuff tears can now be routinely repaired as an outpatient using arthroscopic techniques. Rather than having large incisions and spending several days in the hospital, many cases can be treated with several small incisions, using specialized instruments and an approach that is much less invasive than an open operation.

COLLABORATIVE TEAM APPROACH IS KEY TO SUCCESS

Following surgery, physicians work with physical therapists to manage the rehabilitative care that ensures patients can maintain shoulder motion while protecting the repairs.

Not only does therapy allow protection, it will also allow progressive increase in strength and function after the tendon has securely healed to the bone.

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Successful management of rotator cuff injuries depends on a collaborative team effort between you, your surgeon and your physical therapist.

Although surgeons play a key role in repairing damaged structures, the patient’s body and cellular structure does the real work by ultimately allowing the tendon to reform the connection to the bone.

The treatment of shoulder pain and rotator cuff tears is an individual process for each patient. The goals of managing these problems remain relieving pain and improving function. The path towards achieving these goals starts with an open conversation with your doctor and continues with a collaborative effort between you, your surgeon, your physical therapy team and your body.

My grandfather spoke with his surgeon, ultimately went on to have his rotator cuff successfully repaired, and is still active today.

ABOUT THE AUTHOR

Dr. Richard Harrison

Dr. Richard Harrison

Dr. Richard Harrison is a graduate of the Baylor College of Medicine and completed his internship and residency in Orthopedic Surgery at Jackson Memorial Hospital in Miami, Florida, followed by a Hand and Limb Fellowship at St. Luke’s/Roosevelt Medical Center in New York City, which also included training in Melbourne, Australia and congenital hand surgery training at Texas Scottish Rite Hospital in Dallas, Texas.  He is Board Certified in Orthopedic Surgery with additional sub-specialty board certifications in Hand Surgery and Sports Medicine.

At First Choice Medical Group, Dr. Harrison’s practice focuses on total shoulder replacements and replacement revisions, rotator cuff repair,  fracture treatment, sports injuries and hand surgery.


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