State of the Art Treatment Options for Rotator Cuff Tears

By Evan H. Karas, MD FAAOS | Orthopedics

Whether it’s combing our hair, scratching our backs, getting dressed, or just reaching for a snack in the fridge, many everyday activities require us to lift our arms. But people with a rotator cuff tear in their shoulders can’t make these normal movements without pain and weakness, sometimes extreme.

Rotator cuff tears aren’t rare. According to the American Academy of Orthopaedic Surgeons, approximately 2 million Americans each year visit doctors because of problems with their rotator cuff. But what does this mean?

A network of 4 muscles joining together as tendons to cover the head of the upper arm bone, the rotator cuff plays a crucial role. It keeps the arm in the shoulder socket and helps lift and rotate the arm. So when the rotator cuff becomes torn, it can present a big problem demanding effective treatment.

Not All Tears Are the Same

Rotator cuff tears can vary. There are two primary causes: The first is degeneration, meaning the tear happens slowly. This often happens as people age and can’t necessarily be prevented. But several factors can contribute to this degeneration, including repetitive stress created by constantly performing the same shoulder motions, such as weight-lifting or throwing; diminished blood supply; or bone spurs, which are bony overgrowths that can develop in the shoulder, rubbing the tendon.

The second main cause of torn rotator cuffs is injury, which can show up as a complete and sudden tear. This can occur if you fall on your outstretched arm or lift a heavy object using a jerking motion. Other shoulder injuries, such as a dislocated shoulder , can also lead to a torn rotator cuff.

What are the different types of rotator cuff tears?

• A partial tear involves tissue that is not completely detached from the bone.
• A full-thickness, or complete tear involves a complete separation of the tendon from the bone.

Conservative Treatment Options

Rotator cuff tear treatment typically starts with “conservative” or non-surgical measures. In about 50% of patients, this approach relieves pain and improves function.

Conservative treatment options include:

• A sling may be used for short periods of time for pain control.
• Avoiding certain shoulder movements, such as overhead motion or repetitive motions.
• NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen or naproxen to relieve pain and swelling.
• Physical therapy or specific strengthening exercises to improve shoulder flexibility and range of motion.
• Steroid injections into the shoulder joint to relieve inflammation and swelling.

Surgical Treatment Options

If shoulder pain doesn’t improve over several months with non-surgical treatment, the next step toward relief may be surgery. Those with full thickness rotator cuff tears are best managed with surgical repair.  If left unrepaired these tears can progress and lead to worsen symptoms.

But just as there are different types of rotator cuff tears, different types of surgeries are used to repair them. The technique chosen depends on the size of the tear, a patient’s individual anatomy, and the quality of tendon tissue and bone. Most patients report improved shoulder strength and less pain after rotator cuff surgery.

Surgical approaches include:

• Arthroscopic surgery: By inserting a small camera known as an arthroscope into the shoulder joint, surgeons use tiny surgical instruments to repair or reconstruct the rotator cuff. This minimally invasive technique is typically done as an outpatient procedure.
• Superior Capsular Reconstruction: For tears that have progressed to become irreparable there is now a surgical procedure that replaces the function of the rotator cuff mechanism with a soft tissue graft.
• Shoulder joint replacement: Also known as shoulder arthroplasty, this procedure may be used for massive rotator cuff injuries. An innovative prosthesis known as a reverse shoulder replacement is used to substitute for the rotator cuff function.