Rotator cuff tears are one of the most common reasons why people have shoulder pain. But there are many people who have rotator cuff tears and have no pain. Many rotator cuff tears can be treated without surgery and result in a painless, well functioning shoulder. Some of you may have persistent pain despite medications, injections and physical therapy. Therefore, some of you may wish to consider rotator cuff surgery. This post will help address many of the key questions you should have about rotator cuff tears and whether or not you should think about having shoulder surgery. More than ever it is important that you have a good understanding about rotator cuff tears.
The rotator cuff is made up of 4 muscles which control how well your shoulder works. If a tear in the rotator cuff is large enough it can affect how well the shoulder will function. Most rotator cuff tears are actually due to degeneration of your tendons. Some tears may occur because you were injured… such as a fall, or sports injury.
5 Facts You Must Know About Rotator Cuff Tears:
- The most common cause of a rotator cuff tear is degeneration. That means your tissue simply wore out over time. These tears can become larger with time, but that is not always the case. Many degenerative tears are very small. Many patients with degenerative tears can avoid surgery. Take home message: Inquire about your type of tear. If you have a small degenerative tear, a discussion about surgery should only occur after you have failed a proper non-surgical treatment regimen. Recent advances have enabled us to repair rotator cuff degeneration and degenerative rotator cuff tears with a biological patch.
- Trauma or injuries can cause rotator cuff tears. If you have fallen on your side, and now you find that you can not move your arm due to pain and weakness, you have likely suffered a large traumatic tear of the rotator cuff. Traumatic tears are treated differently then degenerative tears. In this case, you had a normal tendon which tore because of a traumatic event. These injuries are typically treated with surgery to repair the rotator cuff. Take home message. If you fell and now have significant weakness… do not wait too long before seeing an Orthopedist. If your tear is large, it will retract and turn to fat. It is better to treat these sooner rather than later.
- Retraction and Atrophy. Muscles in our body are under tension. Like a rubber band stretched between two fingers. If a tendon is torn on one end, it will start to retract or pullback towards the other end. If you have a large tear, then your rotator cuff tear can retract significantly. If it has retracted more than 3 centimeters the repair might be difficult to perform and your result might suffer, or degrade with time. When a muscle is not functioning well, it will turn to fat. Our body is cruel! If you have had a tear for a while, then there is a chance that the muscle has turned to fat.. and is NOT capable of working like a muscle. Unfortunately, once a muscle has turned to fat, it can not turn back into muscle. Take home messages: Talk to your doctor. Is your tear retracted? How far? Ask how that will affect your ultimate result. Do you have fat replacement of the muscle? How much? If it is significant, you may not be happy with the result of an attempted repair.
- Just because something is torn, does not mean it needs to be fixed. I see far too many second opinions where people had an MRI, were diagnosed with a small tear and told that they need surgery. The reason given for the need for surgery was simply because something was torn. That’s simply not true. Many people are living with tears of their rotator cuff and do not even know they have one. Just because something is torn does not mean it needs to be fixed. Take home message. If you have not had trauma or a serious injury and you are diagnosed with a small tear and have not been offered non-surgical treatment options it’s time to see a second opinion.
- Be treated like a person… not an MRI finding. All people are not created equal. All tears are not created equal. When determining what the proper treatment option is for you, your surgeon must take into account the type of tear you have, your story, your goals, your current quality of life and whether or not those goals are achievable given your exam, and your MRI findings. Take home message: Not all tears require surgery. Not all tears can be repaired. What are your goals? They matter! Are they achievable — with or without surgery? Don’t be afraid to ask questions.
Rotator cuff tears : Because you likely have more questions… see these articles for more information.