If a rotator cuff tear has made combing your hair or getting dressed difficult to do — or playing your favorite sports is all but impossible — arthroscopic rotator cuff repair surgery may offer the best chance to get back to an active lifestyle quickly and safely.
Many of the two million or so people in the United States who see their doctors each year because of weakness and pain due to a rotator cuff problem aren’t aware how common this shoulder injury is for men and women ages 40 to 90. But options for resuming their lives and being able to play sports again pain-free is possible.
The rotator cuff helps to lift and rotate the arm and is powered by a group of four muscles that join as tendons to cover the head of your upper arm bone. If one or more of the four rotator cuff tendons is torn, it may weaken the shoulder, making everyday activities difficult and painful. Even more exacerbating is the inability to lie on the shoulder when sleeping.
Two common reasons that account for rotator cuff tears are a traumatic injury or wear and tear. No matter the mechanism, getting a diagnosis with a correlation by MRI is the first step to resolve symptoms.
Who gets rotator cuff tears? Any adult can develop the condition, but most tears happen slowly over time — especially in those over 40 — and occur in a person’s dominant arm. People who do a lot of lifting or overhead movements and are not bending their elbow when performing a task are particularly vulnerable as well.
Athletes suffer more rotator cuff tears due to overuse, especially baseball pitchers, tennis players and other “overhead” athletes. And workers whose jobs require much arm movement over their heads, like painters and carpenters, are also at increased risk.
How can you tell if your rotator cuff is torn? The most common symptoms include:
• Pain on the side or the back of the shoulder at rest, lying down at night or on the affected shoulder.
• Pain when lifting and lowering the arm at your side with low weight.
• Weakness when holding your arm at your side and trying to place it behind your back.
• Weakness of the arm when reaching for a quart of milk from the refrigerator with a straightened arm.
If the rotator cuff tear occurs suddenly, such as from a fall or a sports injury, severe pain is a major clue. That may get better over a few days, but the weakness will persist.
If pain and weakness due to a rotator cuff tear don’t improve with time, rest and medication, a definite diagnosis is imperative. A certified shoulder surgeon may consider surgery to repair the tear, which involves reattaching the tendon to the head of the upper arm bone. The size of the tear — with those larger than 3 centimeters more likely to need operative care — and the acuteness of the injury and weakness are all factors in repairing the tear.
While several surgical techniques could do the job, arthroscopic repair is the least invasive way to fix a torn rotator cuff. During this type of surgery, a small camera is inserted into the shoulder joint that emits images the surgeon can use to guide movement of small surgical instruments inside the joint. Only tiny incisions are needed because of the small size of the camera and surgical tools, and the surgery is done on a same-day, outpatient basis.
Arthroscopic rotator cuff repairs include less postoperative pain, less blood loss and less chance of complications such as infection when properly done, with rare use of any narcotic.
Arthroscopic rotator cuff surgery enables patients to return much more quickly to work and sports, although it is usually no sooner than four months for vigorous sports to avoid a re-tear, meaning less disruption and a better experience overall. Hands down, it’s the type of surgical rotator cuff repair I rely on most for my active patients.
Kevin D. Plancher, MD, MPH, is a board-certified orthopaedic surgeon and the founder of Plancher Orthopaedics & Sports Medicine, a comprehensive orthopaedics and sports medicine practice with offices in Greenwich and Manhattan. For more, visit plancherortho.com.