By: Kevin F. Bonner, MD, FAAOS
What will one in five Americans have in common by the age of 70?
Kevin F. Bonner, MD, FAAOS is an orthopedic surgeon with the Jordan-Young Institute, located in Virginia Beach.
Chances are they will have a partial or full thickness rotator cuff tear. The rate is probably higher for a partial tear. Fortunately, not all tears require surgery. For many, especially younger, more active people, surgery is an option to decrease pain and improve shoulder function.
The rotator cuff is a group of tendons surrounding the top or cuff of the shoulder joint. Because of how and where these tendons attach to shoulder bones, they are susceptible to damage over time.
Common thinking is that rotator cuff injuries only occur in athletes. Actually, many people middle age or older tear their rotator cuff doing everyday activities such as starting a lawn mower or throwing out a trash bag. Cuff tears are also not likely from a single incident.
More often, they come from years of living, reaching, lifting, combined with a condition called impingement of the shoulder, when the rotator cuff is crowded or pinched during activities like reaching.
The final straw can be a strenuous lifting move or what seems like a minimal injury, if the rotator cuff tissue has deteriorated over time. In this setting, the patient often experiences more acute pain and weakness in the shoulder which may indicate a tear has occurred or worsened.
5 Misconceptions of Rotator Cuff Tears
Cuff Tears Only Happen to the Pros
Cuff tears have been known to quickly put a relief pitcher out of commission, but likely the most common reason for cuff tears is anatomy. People with certain shaped shoulder bones have more narrow space for the rotator cuff tendons, and they are at greater risk for tears over time. Impingement is a term used when the rotator cuff is crowded or pinched during activities like reaching or lifting. Years of rubbing or pinching the rotator cuff tendon can weaken it over time. At some point, this weakened tissue tears.
The wear of the rotator cuff is similar to the wear parents see with their child’s pair of jeans. Even before a complete hole wears in the knees of jeans, you can begin to see superficial tearing of threads. Of course, over time this weakened material is susceptible to tearing all the way through.
When a rotator cuff tears, it’s the collagen threads of the tendon tearing where the tissue has weakened.
Everyone Needs Surgery
Not everyone with a cuff tear needs surgery. Whether you’re 65 or 75 years old, your lifestyle and daily activities may not warrant surgery. Loss of tissue strength is part of the aging process and this includes our rotator cuffs. Older people may respond quite well to treatments other than surgery.
Many factors go into deciding whether surgical repair is warranted. This is a discussion for you and your doctor. For many patients, the decision to have surgery is more about doing activities they want to continue doing without the pain. As a general rule, the younger and more active the patient, the more they tend to require repair.
Younger people suffering from shoulder pain associated with lifting their arms should take note.
A word of caution is that you can wait too late for surgery. Sometimes tears can not be fixed. It’s disheartening as a doctor when you have to tell a patient, they’ve waited too late for their rotator cuff to be repaired successfully. Most of the time this can be determined using an MRI before surgery.
Also, there are a lot of people with impingement of the shoulder who have pain even prior to a full rotator cuff tear, who can benefit from increasing the space for their rotator cuff. This is performed arthroscopically and the recovery is a lot quicker when compared to a rotator cuff repair.
It’s only painful for the person with the tear
The night pain of rotator cuff tears can wake up the household. Interestingly, spouses and significant others of people suffering a rotator cuff tear are often behind the initial doctor’s visit to restore a good night’s sleep for all. It’s not proven why night shoulder pain is so closely linked to rotator cuff tears, but persistent night pain, and disrupted sleep can lead people to seek care.
Fixing the rotator cuff arthroscopically speeds up the healing process
The minimally invasive technique of using a scope with a camera and magnifying lenses is on the rise. Most rotator cuff tears are done using this method for a less invasive and less painful procedure.
But, this approach does not speed healing. The rotator cuff tendon still has to heal.
There’s no mistaking that our bodies wear over time. Some body shapes and bone structure may increase the odds for wear that could lead to a rotator cuff tear. How a cuff tear affects your life and lifestyle is a matter to consider with your physician. For younger people with the shoulder pain that signals a cuff tear, don’t wait too long to be evaluated.
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