Rotator Cuff Surgeons in Dallas, TX
Rotator Cuff Tear
Rotator cuff tears can be a severe source of shoulder pain. The rotator cuff consists of four shoulder muscles, as well as their tendons, which are basically strong fibers that connect the muscle to the bone. The shoulder muscles and tendons cover the upper end of the arm bone, forming a cuff.
Risk of Rotator Cuff Tears
The risk of rotator cuff tears increases with age. As you age, the tendons and muscles start to degenerate and weaken. Rotator cuff tears can also result from sudden shoulder movements or overuse of the shoulder.
Rotator Cuff Treatment
The form of treatment for rotator cuff tears comes down to a case by case basis. Some rotator cuff tears can be treated with non-surgical methods. However, as technology progresses, surgical procedures have become less invasive, resulting in good outcomes with improved recovery times.
Rotator Cuff Anatomy
The shoulder is composed of three bones:
- The humerus-upper arm bone
- The clavicle-collarbone
- The scapula-shoulder blade that moves on our back
- An edge of the scapula-called the acromion, forms the top of the shoulder
There are a total of four joints in our shoulder complex. The humerus and the scapula form the main shoulder joint, the glenohumeral joint.
The glenohumeral joint is not a true ball-in-socket joint but is similar, in structure, to the hip. The top of the humerus is round, similar to a ball. It rotates in the shallow basin, referred to as the glenoid, on the scapula. A group of ligaments, called the joint capsule, are responsible for holding the ball of the humerus in position. Ligaments are strong tissues that provide stability.
These four muscles form a single cuff of tendon that connects to the head of the humerus bone. Why is this important? These muscles allow the arm to rotate, move upward to the front, back, and side.
How are you able to painlessly move your arm around in these motions? A fluid-filled sac, called the subacromial bursa. The subacromial bursa lubricates the rotator cuff tendons, and this allows us to perform smooth and painless motions. We use the rotator cuff muscles to perform overhead motions, in general, such as reaching for something higher up.
These motions, although they aren’t used frequently in everyday life, are used repeatedly during sports.
Causes of Rotator Cuff Tears
Rotator cuff tears most commonly occur in the dominant arm but occur in the non-dominant arm, as well. Like we said earlier, risk of rotator cuff damage increases with age. In short, with age, the blood supply to our tendons decreases. This causes the tendons and muscles to degenerate, weaken, and become susceptible to tearing, as with many other muscles in the human body. The body’s ability to repair the tendon decreases over time because of the reduced blood supply.
With age comes complications for the muscles, and sometimes bone spurs can grow on the scapula. When bone spurs or bursa inflammation narrows the space for rotator cuff tendons, this is known as shoulder impingement syndrome. The tendons may tear when they rub across the bone spur, more specifically, when the arm is elevated.These inflamed tendons may develop tendonitis, which is a painful condition.
Rotator cuff injuries aren’t limited to those who are aging. It can occur in younger people following a shoulder injury. Overuse of the shoulder or repetitive activity can also cause rotator cuff tears. This includes athletes that perform overhead movements specifically in sports such as tennis, swimming, or baseball.
Symptoms of Rotator Cuff Tears
The symptoms of a rotator cuff tear, more often than not, tend to appear gradually. The pain pay first develop in the front of the shoulder. Eventually, the pain may spread down the side of the arm. Rotator cuff tear pain may be mild at first and increase when the arm is lifted over the head or to a fully extended position. It’s hard to know how rotator cuff tear pain will affect the individual, as some rotator cuff tears are not painful at all.
Common symptoms of a gradual tear include:
- difficulty moving the arm
- crackling noise when moving the arm
- arms feel weak, especially when lifted or rotated
Common symptoms of a traumatic injury tear include:
- feeling a “snap”
- feeling a sharp, sudden pain
- arm feels weak immediately
- difficulty moving arm
Rotator Cuff Tear Diagnosis
A doctor should evaluate your shoulder via x ray, to see the condition of the bones in your shoulder and to identify arthritis or bone spurs, and a physical exam.
A special dye may be used with the X-ray in a procedure called an Arthrogram.
Sometimes soft tissue injuries do not show up on an X-ray. In this case, your doctor may order an MRI or an ultrasound. An MRI scan will provide a very detailed view of your shoulder. An ultrasound uses sound waves to create an image of your shoulder
The doctor will more than likely ask you about your symptoms and medical history. The doctor will then ask you to perform simple movements. This is help the doctor assess your muscle strength, joint motion, and shoulder stability.
Rotator Cuff Repair Treatment
Most rotator cuff tears can be treated with non-surgical methods including rest and pain relief. Limiting overhead arm movements and wearing a sling should actually help to reduce symptoms. Your doctor may prescribe you medication or tell you to take over the counter medications to reduce the pain and swelling. If the symptoms do not improve, you may need physical or occupational therapy to help restore the shoulder function.
Rotator Cuff Tear Surgery
Surgery is recommended only when the non-operative treatments have provided minimal or no improvement. Rotator Cuff surgery may also be recommended for very painful injuries or for those who rely on their arm strength for work or sports.
Types of rotator cuff surgeries include:
- Partial rotator cuff tears may only require debridement, which simply trims the tendon. Suturing the tendon together repairs a complete tear. Also, tendons can be reattached to the bone. Most can be done as outpatient procedures. Three common surgical approaches include Open Surgical Repair, Mini-Open Repair, and Arthroscopic Repair.
- Open Surgical Repair is the original surgery for rotator cuff tears. The surgeon will open the shoulder complex to gain access to the torn rotator cuff. The surgeon will then make an incision over the shoulder and detach a small portion of the deltoid muscle.
- A Mini-Open Repair of the rotator cuff is one variation of the Open Surgical Repair but uses much smaller incisions, typically three to five cm. Instead of detaching the deltoid muscle, the surgeon views and evaluates the joint using an arthroscope.
- The All-Arthroscopic Repair is a technique that is commonly used to reconstruct ligaments or remove damaged tissue and bone spurs. Arthroscopy is less invasive than traditional surgical methods. It has a decreased risk of infection and a shorter recovery period. For this, the surgeon will make one or more small incisions, about ¼” to ½” in length, near the shoulder joint, and then fills the joint space with a sterile saline solution. By expanding the space, the surgeon will have a better view of the joint structures. The surgeon will then insert the arthroscope. Because the incisions are so small, they will require just a few stitches.
Rotator Cuff Surgery Recovery
Your shoulder will need several weeks to heal from the surgery. What this means is that you must restrict your arm movement for a time following the procedure and will more than likely wear a sling anywhere from four to six weeks.
Then you will visit a physical therapist or occupational therapist to help you get back to your daily lifestyle by slowly progressing towards strengthening exercises. Most individuals will regain their strength and functionality by four to six months post-surgery. The recovery time will depend on the extent of your surgery, condition, and a few other factors.
Rotator Cuff Tear Prevention
Staying in good health can only do good. It may be helpful to exercise to maintain a strong, stable, and flexible shoulder. Avoiding repetitive overhead movements may help to prevent rotator cuff tears.
At Sports Physicians Orthopedics and Rehabilitation of Texas (SPORT), we treat athletes with a variety of shoulder and elbow injuries. The shoulder is one of the most versatile joints in your body. It provides a substantial amount of flexibility and range of motion. Because of this, it is one of the joints most vulnerable to pain and injury.
Athletes who participate in sports that require overhead and rotational motions such as baseball, softball, swimming, weight lifting, gymnastics, volleyball, and tennis are most likely to incur shoulder injuries.
Depending on the specific condition and its severity, these treatment options may include physical therapy, over-the-counter anti-inflammatory medication, slings and supports, cortisone shots, or shoulder or elbow surgery.
If you have an acute or chronic shoulder or elbow injury that needs medical attention, call SPORT at (469) 200-28322 to arrange a consultation or you can request one online. Hurt today? We can arrange a same-day urgent care visit to ensure you get fast, effective relief.