Rotator Cuff Tears
Rotator cuff tear is a common cause of shoulder pain in middle-aged and old people. However, it can occur at any age. A rotator cuff tear can occur due to injury such as forward fall on an outstretched hand, or on lifting a very heavy object with a jerk. Repetitive actions especially involving overhead hand movements such as swimming, playing tennis and games involving throwing a ball (cricket, baseball), and keeping things on overhead shelves can cause a rotator cuff tear. The condition makes even simple tasks like brushing the hair or reaching your own back very difficult. Pain can be felt even in the night while resting.
Rotator cuff is a group of four tendons that join the head of the upper arm bone (humerus) to the shoulder muscles. Tendons are the muscle extensions, which join muscle to bone and allow the muscle to control the movement of the bone. Thus by pulling on the tendons the shoulder muscle can move the arm.
The cartilage structure of the tendons accumulates changes with age and overuse (degenerative changes) of shoulder. With age, blood supply to the rotator cuff tendons decreases and also the ability to repair the changes in its cartilage structure, which over the time may lead to a tear. Bone spur or overgrowth of a shoulder bone may also occur with ageing and put mechanical pressure on the rotator cuff tendons below it, causing shoulder impingement. If not treated, impingement may finally cause the tendon to tear below the bone overgrowth. Repetitive actions of the arm also cause change in the cartilage structure making the tendons weak and more prone to rupture or tear. Tear of the tendons of the rotator cuff is known as rotator cuff tear. The tear is mostly noticed in the arm, which is most often in use. Thus, for a right-handed person, the tear is mostly in the right hand and for left-handers, in the left hand. It may be partial or complete. A complete tear leads to complete detachment of the tendon from the head of the humerus, whereas, a partial tear is the rupture of the tendon at a place where the tendon is still attached to the shoulder muscle.
Tear due to injury causes sharp strong pain with swelling and tenderness in front of the shoulder. In case of partial tears, there will be pain in the shoulder, but you can still move the arm. Whereas, in complete tears you cannot move the arm, especially raise the arm from your side, on your own.
Degenerative changes in the rotator cuff initially lead to mild pain in the shoulder with activities involving raising the arm. Pain is even felt in the affected shoulder when resting on that side at night. Initially, taking pain killer medications may provide relief, but slowly over time, the intensity of the pain increases and medications will no longer be effective in reducing the pain.
The doctor will ask you about your symptoms and medical history. He will then examine the strength of the arms and the shoulder movements that are possible in the current situation. He will ask for an X-ray in case he suspects bone spur to be the cause of the rotator cuff tear. The X-ray cannot show soft tissues like tendon, so to further visualize the amount of tear and the position of the tear he may ask for an MRI or an ultrasound. Sometimes, shoulder arthroscopy is used to access the tear.
Chronic shoulder and arm pain, even though mild, should not be neglected. If it is due to the tear of the rotator cuff, the tear will increase with use and so will the pain. To treat partial tears the doctor will ask you to rest the affected arm and may put it in a sling. Pain medications will be prescribed to reduce the pain and some physical exercises of the shoulder will be advised to increase the mobility and strength of the shoulder muscle. If rest, medication and exercises do not provide any pain relief, corticosteroid, a strong anti-inflammatory drug, along with a local anesthetic may be given as an injection in the shoulder in the space below the bone spur and above the rotator cuff. Surgery will be advised if:
- Nonsurgical treatment for a year or so is ineffective
- The tear is large or complete
- The tear restricts activities, especially for a professional sports player
- The tear is due to a severe injury
To plan the surgery, the doctor may ask for an MRI or arthroscopy. Arthroscopy is a minimally invasive surgical procedure done under local or general anesthesia using an arthroscope. An arthroscope is a pen-thick instrument. It consists of a lens, a light system and a camera. A button-sized hole is made in the shoulder and the arthroscope is inserted through the hole. Fluid flows through the arthroscope and provides the surgeon with a clear view of the inside of the shoulder joint. It also minimizes bleeding. The surgeon can see the images from the arthroscope on the monitor. If necessary, surgical instruments are introduced in the joint through separate holes – one or three – depending on the type of repair need to be done in the joint. After surgery, the incisions are closed by stitching or with small sterile bandage strips. You will be kept in the hospital for few hours after the surgery for observation, and will be discharged on the same day.
- If the damage is partial, the degenerative tissue of the tendon is removed using surgical tools. The tear is left to heal on its own.
- If the bone spur is causing the tear and the tear is small, the front edge of the bone is removed to prevent pressing of the rotator cuff, and the torn tendon is sutured (acromioplasty).
- If the tear is complete, the degenerative tissue of the torn tendon is removed; front edge of the bone spur (acromion) is removed along with some of the bursal tissue. Bursal tissue is present below the bony process to prevent friction between the bony process and the rotator cuff. Four to five millimeter of the clavicle, a bony process is also removed to increase the space for the rotator cuff muscle. The humerus bone head where the tendon was attached is cleaned and all the soft tissue is removed. The raw bone surface is exposed and holes are drilled into the humerus bone to accommodate the suture anchors. Suture anchors, nowadays, are made up of bio absorbable material that dissolves in the body on its own with time. Occasionally, metal anchors are used and they stay there in the bone permanently. The tendons are then sewn to the anchors on the bone. The incisions are closed by suturing or by the tape. It is much safer and less painful than open surgery.
- If the tear is severe or old, open surgery is performed. In this, a long incision is made on the front side of the shoulder. The outer muscles are cut to reach the rotator cuff. The same procedure is done through open surgery as done in arthroscopy.
- If the tear is long and the tendon cannot be stretched to the bone, tendon grafting may be done to extend it and then it is reattached to the bone. The procedure is complex and is rarely used.
After the surgery, pain medications are given to reduce pain and shoulder exercises are advised to regain mobility and strength of the shoulder. Over the period of time, healing occurs, and the tendons reattaches to the bone naturally.
Rotator cuff tear is a common cause of shoulder pain in middle and old people. It may occur due to injury or degenerative changes. Treatment depends on the degree of tear. Rest, pain medication, and shoulder strengthening exercises provide relief in partial tears but more severe tears require surgery. Surgery provides relief from pain in most of the cases, but the functional mobility of the shoulder joint may vary from individual to individual after the surgery.
To request an appointment, please enter the information on the form on the right and press the “Continue” button to start the appointment request process.
Houston Shoulder Specialists
Advanced Orthopedics and sports medicine has numerous Board Certified/Eligible physicians who are thoroughly educated in the latest treatment techniques both surgical and conservative. They are well versed in advances in shoulder treatments including arthroscopic rotator cuff and Bankart repairs, shoulder stabilization procedures, total shoulder replacement and reverse shoulder replacement.
Drs Elbaz and Brooks now perform Platelet-Rich Plasma (PRP) injections for the treatment of rotator cuff tendinitis, and biciptal tendonitis. PRP stimulates a more rapid healing of tendon, ligament, muscle and bone.
Contact us today to Schedule an Appointment or call us at 281-955-2650 to learn more about our Shoulder Treatment options.
1Professional Building II At North Cypress Medical Center
2North Cypress Professional Building At Lakewood Crossing
3North Cypress Professional Building At Towne Lake
4Houston Professional Building
What Our Patients Are Saying
Thank you for the opportunity to express how pleased I am with the excellent care of Stacy A. Bacon, M.D. I have confidence in her ability to care for me as she successfully partially replaced a broken hip 10 years ago, 2007. I also want to compliment Cheryl who set up the appointment. She represents Advanced Orthopaedics & Sports Medicine very well.
It’s been over 8 years since Dr. Bacon replaced by right ankle. I still can’t thank her enough for the years of pain free walking I have done since! And I’m still going strong! I had numerous breaks in my ankle due an auto accident, repaired/set by a different doctor, after multiple surgery’s, I was still limping, in great pain every day. Then I found Dr. Bacon, now, no more pain, NONE, and no more limping after this ankle replacement. I rave about her constantly and would recommend her to anyone who has a foot or ankle issue
I had been in so much pain with my back for years. It got so bad that I knew I had to do something. I went to Dr Mohr for help. I was so afraid to have spine surgery as I had heard so many horror stories. He and his staff were very informative. I was amazed at the new technology in spinal surgery. December 8, 2016 I had rods and pins put in my back. I am so happy I did now. I am healing really fast and the pain is going away as my body heals. Thank you Dr Mohr for you expertise and sensitive nature. You were understanding about my fear and helped assure me so I could receive the help I needed. You are an excellent Doctor.
I have been a patient of Dr. Cubbage for several years. Each time of go there, he always presents a thorough plan of care. From ordering the most appropriate diagnostic tests to making sure you understand each step of his plan of care. He consistently instills confidence that you are the road to recovery.
Plus his assistant Karen is extremely knowledgeable and very caring!
I would highly recommend Dr. Cubbage if you are having any type of spinal issues. I have seen Dr. Cubbage several times over the last 3 years for lumbar pain and numbness in my left leg. Dr. Cubbage explained my diagnostic results in such a way that it was easy for me to understand. He patiently answered all my questions and explained my options. Fortunately, Dr. Cubbage has been able to manage my pain with conservative treatment but know surgery is inevitable. When that time comes, I would choose no other than Dr. Cubbage! And it’s a plus that he has such a kind and caring staff.
For the first time in many years and many knee operations on one leg I am without any knee pain. This is a result of a procedure performed by Dr. Patel.
I made an appointment to see Dr. Patel on the recommendation of Dr. Tanous following knee replacement and several months of continued pain. Dr. Patel explained the procedure to me and explained how we would proceed. The first procedure was to determine if I would be a good candidate for the second procedure. After the first procedure my pain was anywhere from 0 and 5. Dr. Patel explained to me at follow-up that I was not a good candidate for the second procedure due to my pain level being above the 0 to 3 level. After talking for a while I said “any relief would be better than the pain I had been having.” With this it was agreed that I would have the second procedure. It has now been 6 days since the procedure and I am without any pain.
I realize this is only a few days of not being able to sleep, with a pillow between my knee or under my leg at night. I know the pain may come back at anytime but until then it has been well worthwhile. I hope it will last 6 months, if not, I will have the procedure again after 6 months.
Thank you Drs. Patel and Tanous.
Outstanding Physicians. I’ve had two surgeries here, one on my foot with Dr. Bacon, and an extensive back surgery with Dr. Cubbage. I’m new to the area and my wife found me these surgeons. I have to say that each surgery I’ve had with these physicians have had excellent results. I was very pleased with my foot surgery and decided to see Dr. Cubbage for my back. Other surgeons I’ve seen regarding my back only gave me a 50/50 success rate. I have to say, the low back surgery with Dr. Cubbage was like a miracle. Right away, I noticed a difference and I’ve continued to improve rapidly. I’m almost eight weeks out and I haven’t felt this good in years. I’d like to thank Dr. Stacy Bacon for my foot surgery and Dr. Matthew Cubbage for my low back surgery. Without these drastic results, I’d not be walking today. Thank you all very much and I highly recommend your services. God bless you all.
Dr. David R. Mack replaced my right hip in June 2009, and my left in October 2010. I am already able to go places and do things on my own again. His excellent staff are very caring and helpful throughout the entire process, including recovery. The out-patient therapy is the best. I am walking very well now and am very pleased to have my life back. Thank you so much Dr. Mack and your great staff! Sincerely,
Dr. Bacon, I can never thank you enough for what you have done for me and for my daughter, Melia. In 2011, on the first anniversary of my surgery, my wife and I walked for two hours on Copacabana beach in Rio. I also completed a four hour nature walk over rough terrain in The Falklands and hiked to del Fin del Terre at the tip of South America. You are truly a great doctor, and I thank God every day for you and for Dr. Fogarty who recommended you for Melia’s surgery.
When I started, I couldn’t put any weight on my right leg and now I can do virtually anything. While I hope to not need future therapy, this is without a doubt the place I will return to in the future.