One of the most frequent musculoskeletal injuries is the rotator cuff injury. Sometimes this type of injury is not associated with symptoms, but usually it is quite painful. A rotator cuff tear or rotator cuff tendonitis can cause you to experience pain and weakness in the shoulder when using your arms. It can be especially painful to lift the arm higher than shoulder level. Luckily, there are a number of ways to treat rotator cuff injuries – both surgical and non-surgical. The type of injury you have, your condition, and your age will be determining factors in deciding which type of treatment is right in your situation.
Rotator cuff injuries occur in two ways. You could either have rotator cuff tendonitis or a rotator cuff tear. It is important to realize that there are a few other conditions that can cause the type of pain one experiences with a rotator cuff injury. For an accurate diagnosis, you will need to see your physician. The first step your physician will take is a physical examination. Following the examination, your doctor may inject your injured shoulder with a local anesthetic. This process will help your doctor in determining exactly what kind of injury you have. If your doctor decides that you have a rotator cuff tear, he or she may send you for some imaging tests. Imaging tests will help pinpoint the location of the injury and confirm whether or not the injury is a tear.
It is far more common for the diagnosis to be rotator cuff tendonitis; however, the treatment for tears is very similar to the treatment for tendonitis. Both can be treated conservatively with what is known as RICE therapy. That is: rest, ice, compression, and elevation. You may also want to use an over-the-counter pain medication like ibuprofen. Additionally, your doctor may give you a referral to a physical therapist to learn how to modify your movements and to get a list of exercises that may be beneficial to you. If your tendonitis pain persists, your doctor may give you injections of a steroid/anesthetic mixture. These would be administered to the joint to relieve pain.
Of the patients who use this non-surgical intervention, about half report having a decrease of pain and an increase in range-of-motion within six weeks to three months. Aside from efficacy, there are a number of advantages to non-invasive therapy. Surgical risks such as permanent stiffness, anesthesia complications, and infection can be completely avoided. With non-invasive therapy, there is no down-time for recovery. On the other hand, use of non-invasive techniques may cause an increase in the size of the tear. While there is not a recovery period, there may be a time period when the patient is able to do less. Of course there is also the chance that the non-invasive technique simply will not work. In this case, your doctor may recommend surgery. Your doctor may also recommend surgery if your injury is so severe that he or she feels a non-invasive approach would not be effective.
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There are three ways to treat a rotator cuff injury surgically:
1. Open repair surgery: With this option, the surgeon makes a full incision into the shoulder. This method gives the surgeon a great deal of freedom of movement; however, it is the largest incision option of the three available methods.
The second method is mini-open repair surgery. While this method is similar to open repair surgery, it differs somewhat in that it utilizes arthroscopy. The use of arthroscopy allows the surgeon to make a smaller incision, leaving a smaller scar. This method is an outpatient procedure.
3. All arthroscopic surgery: This option is an outpatient procedure, and it uses the smallest incision.
The doctor will determine which procedure will work best based on the specific injury.
Happily, rotator cuff surgery is a highly successful surgical procedure. Eighty to ninety-five percent of patients who have this type of surgery report successful results, improved range-of-motion and a significant decrease in pain in six months or less.
The expertise of the surgeon is a very important factor in the successful outcome of the surgery. However, there are some variables to keep in mind when considering speed and success of recovery. Among them are the type of tear, tissue quality, the patients age, and the amount the patient complies with the doctors instructions.
It is rare to experience complications with rotator cuff surgery. Tendon re-tear, which is the most commonly experienced complication, only occurs in about 6% of patients. One or two percent may have nerve injury. As little as one percent of patients may contract infection. Detachment of the deltoid muscle and/or stiffness are experienced by fewer than one percent of patients.
Dr. Edelson is a Board Certified Orthopaedic Surgeon specializing in sports medicine. His clinic, Sports Medicine Oregon, focuses on athletes of all ages. Click here to learn more about Dr. Edelson, Portland ACL Reconstruction and Portland Bicep Injuries.
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