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Shoulder Pain? What is a Rotator Cuff Tear

Rotator cuff tears are a common cause of shoulder pain and functional limitations.  The rotator cuff complex is a group of four tendons with muscles that encompass the shoulder joint.  The main purpose of these tendons and muscles are to provide stability and normal biomechanics for the shoulder joint as well as strength and mobility.

Pain is the most common symptom of a rotator cuff issue and in particular with positions above the shoulder or reaching behind or across the body.  The pain often is felt in the upper arm / deltoid region.  Shoulder weakness is another common symptom of a rotator cuff tear.   Weakness and pain may cause difficulty lifting the arm up overhead as well as with carrying and reaching for objects.  Often times, the pain may be more noticeable at night and impede sleeping secondary to pain.

Most rotator cuff tears occur without any specific fall or trauma and present as a pain and limitation that is simply not improving with rest and activity modifications.   A proper review of history and evaluation with a physical examination by a shoulder expert and imaging studies help determine a rotator cuff and the cause of shoulder pain.

Most complete (full thickness) rotator cuff tears benefit from surgical repair to alleviate pain and restore proper shoulder functioning as once the tendon is torn fully, the muscle attached to that tendon overtime continues to pull on a tendon that is no longer anchored on the other side to bone and the tear size slowly increases.

Most surgeries are now performed arthroscopically with a small number of 2 cm incisions using a small camera to attach the torn tendon back to its insertion point on the humerus to allow normal shoulder functioning and alleviate pain.  This is performed as an ambulatory/outpatient procedure and usually with regional block (arm is temporarily numbed with medication) and either sedation (twilight medication) or general anesthesia.

Depending on the specific procedure, postoperative recovery will require a short-term period of immobilization in a sling for about one month and rarely up to 6 weeks.  After this period of immobilization to allow the tendon to be fully re-attached to the bone, a course of physical therapy as well as home exercises will be recommended to optimize recovery to full shoulder function.

William Schell, MD

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