Rotator Cuff Tears and Tendinitis
Patient Information and FAQs
For more information please visit: ortho.templehealth.org
What is the Rotator Cuff?
The rotator cuff is a group of 4 small muscles around the shoulder (1. supraspinatus; 2. infraspinatus; 3. teres minor; 4. subscapularis). These four muscles attach to the humerus or upper arm by tendons that grow into the bone. The four muscle function together like 4 reigns pulling on a horse to lift and rotate the arm.
The rotator cuff muscles are especially important in stabilizing the shoulder with overhead activities and providing power for certain sporting activities (throwing a baseball or football; swimming; playing tennis).
How is the rotator cuff injured?
Most rotator cuff injuries result from overuse that causes swelling or inflammation in the rotator cuff muscle/ tendons. Once inflamed and swollen, the tendons can be pinched by the surrounding bones of the shoulder (bone spur or subacromial spur). This leads to more inflammation/ swelling and the cycle continues. This is commonly referred to as rotator cuff tendonitis, bursitis or “impingement syndrome”.
When inflammation and impingement persist, the cuff may begin to tear, similar to a frayed piece of rope. Partial tears or fraying can progress to full-thickness tears when the tendon becomes completely detached from bone.
In rare cases a severe injury (fall from height; sports injury) can tear the rotator cuff directly off of the bone.
How do I know if my rotator cuff is injured?
People with rotator cuff injuries typically experience pain that is worse at night or with overhead activities. Difficulty sleeping because of the pain is common. With larger rotator cuff tears, patients will experience weakness or difficulty doing their normal activities or exercise routine.
Rest and over-the-counter medications may relieve symptoms temporarily, but if pain and/or weakness persist rotator cuff injury is likely.
Do I need Xrays or MRI?
Shoulder xrays are routinely performed. This allows your doctor to rule out other serious causes of shoulder pain. This also provides the best picture of the surrounding bones and potential bone spurs.
Your doctor will likely suggest an MRI if a rotator cuff tear is suspected. This could be after a serious injury or if significant weakness is noted on physical exam. If rotator cuff tendinitis/ bursitis is treated for >6 weeks without significant improvement, you should have an MRI performed. An MRI will best show if a rotator cuff tear is present.
How are Rotator Cuff injuries treated?
Most rotator cuff injuries (tendonitis/ bursitis/ impingement) will respond to non-operative treatment. This consists of anti-inflammatory medication, physical therapy and in some cases, an injection of steroid medication. The goal of physical therapy is to reduce swelling and inflammation while improving motion and strength.
Will I need surgery?
If a large rotator cuff tear is present, surgery is typically recommended. Symptoms may wax and wane, but the actual rotator cuff tear rarely heals by itself. Instead, tears tend to progress leading to worsening pain and weakness. Once the tendon is detached from bone, the muscle shortens like a spring, pulling the tendon further and further away from the bone.
Some patients without definite tear will have continued pain from tendonitis and impingement of an overlying bone spur. In these cases, if conservative treatment does not meet the patient’s goals, surgery may be an option.
Will this be “Arthroscopic Surgery”?
In almost all cases (95% of the time), rotator cuff surgery can be performed arthroscopically. This can be done with 3-4 small “poke-hole” incisions. A small fiber-optic camera is inserted into the shoulder and images are viewed on a high-definition TV monitor. This allows for evaluation of the entire shoulder including rotator cuff, bone spurs, cartilage, ligaments and the biceps tendon. Small (<5mm) instruments are inserted at the same time to repair or remove damaged tissues or bone spurs.
Because only small incisions are made, physical therapy and recovery can be expedited after arthroscopic shoulder surgery.
How is the rotator cuff repaired?
In most cases, the rotator cuff is repair through the arthroscope. Small suture anchors (figure) or screws with suture are placed in the bone. The suture is passed through the torn tendon and tied, pulling the tendon back to its correct attachment site. These anchors are bioabsorbable, meaning that they dissolve and turn to bone. No metal implants are used and nothing will need to be removed with later surgeries.
In roughly 5% of cases, the rotator cuff may be large and long-standing making an all-arthroscopic repair impossible. In these cases, a small (2-3 inch) incision will need to be made to repair the torn rotator cuff.
After Surgical Repair:
Will I need any other surgery?
In some cases of long-standing rotator cuff injury, the biceps tendon becomes inflamed or partially torn. This will be looked at closely during surgery. If the tendon is torn and/ or a significant cause of pain, a biceps tenodesis will likely be performed. A biceps tenodesis consists of removing the torn portion of the tendon and reattaching the tendon to a new, less painful site. This does not result in any noticeable weakness or dysfunction of the biceps after surgery.
Some patients may have pain related to acromioclavicular (AC) joint arthritis. In these cases, the arthritic end of the bone will be removed to reduce pain and symptoms. This does not result in any residual weakness or deformity.
What happens the day of surgery?
Our staff will assist you through all stages of the process. You will likely require some minor bloodwork, an EKG (heart function test) and Chest Xray prior to any surgery.
You will be called the night before surgery and directed where and when to report. You will report to the preoperative holding area and be “checked in”. Next, you will meet the anesthesia team and discuss your options for anesthesia. Your treating surgeon will review final details and answer any final questions prior to surgery.
After surgery, you will return to the recovery room, where you will be monitored by our nursing staff for several hours. Your family will be able to come back and see you at this point. When you are feeling comfortable, without significant nausea or pain, you will be discharged to home. Nearly all patients are able to go home the day of surgery, but if there are any issues, you can easily be admitted overnight for monitoring.
When can I change dressings/ shower?
The dressings placed on you immediately after surgery may be removed 48-72 hours after surgery. The steri-strips (cloth/paper strips placed over your incisions) may be left on until your first post-operative visit, however if they come off a band-aid or similar cover may be used.
You may shower 3-5 days after your surgery. Do not scrub or soak your shoulder. You may use mild soap and water over the incisions and pat the shoulder dry before reapplying the sling.
How long will I need to wear a sling?
If rotator cuff repair is performed, you will need to be in a sling for 4-6 weeks. You can remove it several times a day for grooming and to perform a few simple exercises.
When can I return to work?
You can return to school or work 5 to 7 days after the surgery, without using the affected arm. If your work requires the use of the involved arm, you will need to be off for a greater period of time. You will need to discuss this with your treating physician.
Will I need to attend physical therapy?
Physical therapy is a key part of recovery after shoulder surgery. You should begin home exercises as instructed the day after surgery. Formal therapy will begin shortly after. The attached physical therapy protocol should be given to your therapist. If questions arise, your therapist should contact your physician to discuss your progress.
When can I return to sports/ full activity?
Every patient’s recovery is different, but in general, most people can return to full unlimited activity at roughly 6 months post-op. This is dependent on your progress in regaining full motion and strength.
What if I have questions?
Do not hesitate to contact any of our affiliated offices. Our staff is available to assist you through this process.
For more information please visit: ortho.templehealth.org