Most people in our culture associate rotator cuff tears with athletes and sports-related injuries. Indeed, rotator cuff injuries frequently affect young, high-level
Rotator cuff injuries – tears, more specifically –
are not limited to athletes. (Photo courtesy of
athletes, especially in the throwing sports. Sudden injuries can also produce cuff tears.
You may be surprised to know, however, that rotator cuff injuries – tears, more specifically, have rapidly become a national health concern and that the vast majority of these tears occur in everyday people as they ramble down the road of life.
In fact, according to Dr. Evan Flatow, renowned orthopedic surgeon and chairman of Mount Sinai’s Department of Orthopedics in New York, the numbers are climbing. “Up to 25 percent of people over the age of 60 will have a rotator cuff tear,” Flatow said. It doesn’t stop there. The older we get, the risk increases significantly. People over 40 are considered at “high” risk, while those over 70 are at “very high risk.”
A rotator cuff is actually a group of tendons that attach to the upper portion of the ball of the upper arm bone, or the “head” of the humerus, forming a type of “cuff” that stabilizes and rotates the arm. Shoulder muscles are attached to the humerus bone by these tendons (there are four) and any one can be the victim of a tear.
Unfortunately, many people don’t pay enough attention to their symptoms and consequently fail to get early treatment before it becomes too late in the game. People generally assume that shoulder pain is a normal product of the aging process and mistakenly confuse it with arthritis pain when, in fact, there could be a rotator cuff tear.
Injuries aside, most cuff tears occur slowly over time. Many begin as a sore, achy shoulder that could be passed off as old age or overuse. Often, there is a predisposing event, such as too much cupboard cleaning or repetitive work above shoulder height that sets off an inflammatory response, and it progresses from there if not treated.
Shoulder impingement (Oh, my aching shoulder featured in the April 10 issue of The Press) is also another situation that can, and often does, lead to a torn rotator cuff. The syndrome typically consists of sub-acromial (under the bony roof of the shoulder joint) bursitis, rotator cuff tendonitis and bone spur formation on the undersurface of the acromion, which rubs and grinds over the rotator cuff, wearing it thin over time. As the impingement progresses and worsens, the rotator cuff becomes thinner and thinner until a tear occurs. Often, these tears can start out as a small “partial thickness” tears and gradually enlarge until it completely separates from the bone.
Diagnosing a cuff tear
Symptoms can include persistent pain, especially “night pain,” loss of range of motion and most importantly, arm weakness. In fact, pain, more than weakness, is often the overriding symptom that brings a person to the surgeon seeking relief. Weakness is most appreciated when attempting to lift the arm or rotate it. During the physical examination, the surgeon will test your arm strength against resistance, both when lifting and rotating. MRI is also a very important tool used in helping to make the diagnosis.
The most common treatment option for a full-thickness torn rotator cuff is surgical intervention. Thirty years ago, it would have been necessary to open the shoulder to asses as well as to repair a tear. With the advent of arthroscopic surgery, the shoulder can be examined under direct vision by inserting the small arthroscope into the shoulder through tiny puncture wounds.
Repair by performing a “mini open” technique, in concert with arthroscopy, has long been and still is considered the “benchmark” procedure for cuff repair, however, with more and more orthopedic surgeons becoming “fellowship trained” in arthroscopic repair techniques, many people are having their cuff tears repaired arthroscopically.
Which is best? There is much debate as to which approach is truly best. Studies have indicated that after enough time has passed post-procedure, there is little, if any difference in success rates. Open procedures tend to be more painful since the shoulder muscles must be dissected to gain entry to the shoulder and cuff.
That said, if you have been diagnosed with a torn rotator cuff, get educated about the different aspects of the surgery and approaches and you’ll be better able to discuss this with your doctor and decide which approach you would want to have performed.
For more information, visit www.bone-and-joint.pain.com/torn-rotator-cuff.htm or the American Academy of Surgeons at www.aos.org.
Chisholm’s expertise in nursing, orthopedics and surgery spans more than 30 years. For more information on orthopedic-related topics, visit www.bone-and-joint-pain.com. Submit questions or comments to Ken at
Fun fact: From age 30, humans gradually shrink in size.