Rotator Cuff Tears

When one or more of the rotator cuff tendons is torn, the tendon no longer fully attaches to the head of the humerus. Most tears occur in the supraspinatus muscle and tendon, but other parts of the rotator cuff may also be involved. In many cases, torn tendons begin by fraying. As the damage progresses, the tendon can completely tear, sometimes with lifting a heavy object.

There are different types of tears.

Partial Tear
This type of tear damages the soft tissue, but does not completely sever it.

Full-Thickness Tear
This type of tear is also called a complete tear. It splits the soft tissue into two pieces.

In many cases, tendons tear off where they attach to the head of the humerus. With a full-thickness tear, there is basically a hole in the tendon.

Rotator Cuff Procedure with Dr. Todd Kim

Cause

There are two main causes of rotator cuff tears: injury and degeneration.

Acute Tear
If you fall down on your outstretched arm or lift something too heavy with a jerking motion, you can tear your rotator cuff.

This type of tear can occur with other shoulder injuries, such as a broken collarbone or dislocated shoulder.

Degenerative Tear
Most tears are the result of a wearing down of the tendon that occurs slowly over time. This degeneration naturally occurs as we age.

Rotator cuff tears are more common in the dominant arm. If you have a degenerative tear in one shoulder, there is a greater risk for a rotator cuff tear in the opposite shoulder — even if you have no pain in that shoulder.

Several factors contribute to degenerative, or chronic, rotator cuff tears.

  • Repetitive Stress. Repeating the same shoulder motions again and again can stress your rotator cuff muscles and tendons. Baseball, tennis, rowing, and weightlifting are examples of sports activities that can put you at risk for overuse tears. Many jobs and routine chores can cause overuse tears, as well. Lack of blood supply. As we get older, the blood supply in our rotator cuff tendons lessens. Without a good blood supply, the body’s natural ability to repair tendon damage is impaired. This can ultimately lead to a tendon tear.
  • Bone Spurs. As we age, bone spurs (bone overgrowth) often develop on the underside of the acromion bone.
    When we lift our arms, the spurs rub on the rotator cuff tendon. This condition is called shoulder impingement, and over time will weaken the tendon and make it more likely to tear. Risk Factors Because most rotator cuff tears are largely caused by the normal wear and tear that goes along with aging, people over 40 are at greater risk.

People who do repetitive lifting or overhead activities are also at risk for rotator cuff tears. Athletes are especially vulnerable to overuse tears, particularly tennis players and baseball pitchers. Painters, carpenters, and others who do overhead work also have a greater chance for tears. Although overuse tears caused by sports activity or overhead work also occur in younger people, most tears in young adults are caused by a traumatic injury, like a fall.

Shoulder Conditions

  • Bankart Lesion
  • Biceps Tendon Rupture
  • Broken Collarbone
  • Burners & Stinger
  • Bursitis
  • Chronic Shoulder Instability
  • Fracture of the Shoulder Blade
  • Frozen Shoulder
  • Labral Tear
  • Rotator Cuff Tear
  • Shoulder Arthritis
  • Shoulder Dislocation
  • Shoulder Impingement Syndrome
  • Shoulder Pain
  • Shoulder Separation
  • Superior Labrum Anterior to Posterior (SLAP)
    • Throwing Injuries[/li_item|

Shoulder Treatments

  • Acromioplasty
  • Arthroscopic Bankart Repair
  • Biceps Tendon Rupture Surgery
  • Biceps Tenodesis
  • Broken Collarbone Surgery
  • Bursitis/Shoulder Impingement Surgery
  • Closed Reduction Shoulder Surgery
  • Labrum Surgery
  • Instability Shoulder Surgery
  • Reverse Shoulder Replacement Surgery
  • Revision Shoulder Replacement Surgery
  • Rotator Cuff Repair
  • Shoulder Arthritis Surgery
  • Shoulder Arthroscopy Surgery
  • Shoulder Impingement Syndrome Treatment
  • Shoulder Separation Surgery
  • Total Shoulder Replacement Surgery
  • Throwing Injury Surgeries

Conservative Treatments

The Orthopedic physicians at Peninsula Bone & Joint Clinic provide conservative treatment options for Shoulder conditions and injuries.

Symptoms

The most common symptoms of a rotator cuff tear include:

  • Pain at rest and at night, particularly if lying on the affected shoulder Pain when lifting and lowering your arm or with specific movements.
  • Weakness when lifting or rotating your arm Crepitus or crackling sensation when moving your shoulder in certain positions Tears that happen suddenly, such as from a fall, usually cause intense pain.
    There may be a snapping sensation and immediate weakness in your upper arm. A rotator cuff injury can make it painful to lift your arm out to the side.
  • Tears that develop slowly due to overuse also cause pain and arm weakness. You may have pain in the shoulder when you lift your arm to the side, or pain that moves down your arm. At first, the pain may be mild and only present when lifting your arm over your head, such as reaching into a cupboard.
  • Over-the-counter medication, such as aspirin or ibuprofen, may relieve the pain at first. Over time, the pain may become more noticeable at rest, and no longer goes away with medications. You may have pain when you lie on the painful side at night. The pain and weakness in the shoulder may make routine activities such as combing your hair or reaching behind your back more difficult.

Diagnosis

Physical Examination & Patient History

During your first visit, your doctor will talk to you about your symptoms and medical history. During the physical examination, your doctor will check all the structures of your injury, and compare them to your non-injured anatomy.  Most injuries can be diagnosed with a thorough physical examination.

Imaging Tests

Imaging Tests Other tests which may help your doctor confirm your diagnosis include:

X-rays. Although they will not show any injury, x-rays can show whether the injury is associated with a broken bone.

Magnetic resonance imaging (MRI) scan. If your injury requires an MRI, this study is utilized to create a better image of soft tissues injuries. However, an MRI may not be required for your particular injury circumstance and will be ordered based on a thorough examination by your Peninsula Bone & Joint Clinic Orthopedic physician.

Treatment Options

Non-Surgical

If you have a rotator cuff tear and you keep using it despite increasing pain, you may cause further damage. A rotator cuff tear can get larger over time. Chronic shoulder and arm pain are good reasons to see your doctor. Early treatment can prevent your symptoms from getting worse. It will also get you back to your normal routine that much quicker.

The goal of any treatment is to reduce pain and restore function. There are several treatment options for a rotator cuff tear, and the best option is different for every person. In planning your treatment, your doctor will consider your age, activity level, general health, and the type of tear you have.

There is no evidence of better results from surgery performed near the time of injury versus later on. For this reason, many doctors first recommend nonsurgical management of rotator cuff tears.

In about 50% of patients, nonsurgical treatment relieves pain and improves function in the shoulder. Shoulder strength, however, does not usually improve without surgery.

Nonsurgical treatment options may include:

  • Rest. Your doctor may suggest rest and and limiting overhead activities. He or she may also prescribe a sling to help protect your shoulder and keep it still.

  • Activity modification. Avoid activities that cause shoulder pain.

  • Non-steroidal anti-inflammatory medication. Drugs like ibuprofen and naproxen reduce pain and swelling.

  • Strengthening exercises and physical therapy. Specific exercises will restore movement and strengthen your shoulder. Your exercise program will include stretches to improve flexibility and range of motion. Strengthening the muscles that support your shoulder can relieve pain and prevent further injury.

  • Steroid injection. If rest, medications, and physical therapy do not relieve your pain, an injection of a local anesthetic and a cortisone preparation may be helpful. Cortisone is a very effective anti-inflammatory medicine.

The chief advantage of nonsurgical treatment is that it avoids the major risks of surgery, such as:

  • Infection

  • Permanent stiffness

  • Anesthesia complications

  • Sometimes lengthy recovery time

The disadvantages of nonsurgical treatment are:

  • No improvements in strength

  • Size of tear may increase over time

  • Activities may need to be limited

Surgical

Your doctor may recommend surgery if your pain does not improve with nonsurgical methods. Continued pain is the main indication for surgery.

If you are very active and use your arms for overhead work or sports, your doctor may also suggest surgery. Other signs that surgery may be a good option for you include: Your symptoms have lasted 6 to 12 months You have a large tear (more than 3 cm) You have significant weakness and loss of function in your shoulder Your tear was caused by a recent, acute injury

Surgery to repair a torn rotator cuff most often involves re-attaching the tendon to the head of humerus (upper arm bone). There are a few options for repairing rotator cuff tears.

Conservative Treatment Options

Dr. Paul Abeyta ~ Orthopedic Surgeon

““I believe that excellent outcomes can be achieved with clear communication and treatment plans that are tailored to the individual needs of the patient. I emphasize injury prevention and utilize a multidisciplinary team which includes highly trained physical therapists. Careful diagnostic evaluation, compassionate care, and application of current medical information and surgical technique are all important for returning patients to their pre-injury level of activity.”

Dr. Paul Abeyta is a board-certified, orthopedic and Sports Medicine surgeon treating patients at Peninsula Bone & Joint Clinic in Burlingame, California.

Dr. Todd Kim ~ Orthopedic Surgeon

“Although I treat many patients with similar orthopedic injuries, I believe that the best outcomes for patients result from individualized treatment plans. Not every injury is the same. And to be sure, every patient has his or her own goals. Whether your hope is to return to a high level of competitive sports or to be able to walk your dog without pain, forming the best treatment plan requires excellent communication and trust with your surgeon. I am committed to listening and working with you to find the best treatment approach for your injury and lifestyle.”

Dr. Todd Kim is an Orthopedic Surgeon specializing in complex and traditional shoulder, elbow, knee and ankle conditions and treatments.

Shoulder Treatment Highlights

Rotator Cuff Repair w/Regenesorb by Dr. Abeyta

Dr. Paul Abeyta utilizes the latest in bio-compatible and advanced healing suture systems available in his Rotator Cuff Repair procedures.

Building on the success of the innovative HEALICOIL PK design, this new suture anchor is the first device to use Smith & Nephew’s proprietary REGENESORB material — an advanced biocomposite that has been shown in pre-clinical studies to be absorbed and replaced by bone within 24 months.

Reverse Total Shoulder Replacement by Dr. Todd Kim

When patients experience tissue permanently retracted in the Rotator Cuff and shoulder area, Dr. Todd Kim may recommend an innovative shoulder replacement option to restore joint function and remove joint compromise. This procedure is called a Reverse Shoulder Replacement.

A standard total shoulder replacement is designed to work only if the rotator cuff muscles and tendons are in tact and working properly. If the rotator cuff muscles are not working properly, a Reverse Total Shoulder replacement is needed.

In a Reverse Total Shoulder replacement, the glenoid component is shaped like a ball and anchored to the scapula by screws. The humeral component then becomes the new socket of the joint and attaches to the upper end of the humerus.

The joint configuration of a Reverse Total shoulder replacement allows the patient to now us the deltoid muscle instead of the torn rotator cuff to lift the arm.

Peninsula Bone & Joint Clinic

The Orthopaedic physicians at Peninsula Bone & Joint Clinic provide comprehensive services to all members of the family.
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