Rotator Cuff Tears
If you have chronic pain or weakness in your shoulder, it may signal a rotator cuff tear. While rotator cuff tears can be treated without surgery, a surgical procedure may be necessary to repair the tear and return your ability to lift and reach overhead. Duke shoulder surgeons evaluate the severity of your rotator cuff tear and recommend the most appropriate treatment, including non-surgical approaches and physical therapy. Our goal is to lessen your shoulder pain and return your shoulder strength and function, so you can get back to the activities and sports you enjoy.
What Causes Rotator Cuff Injuries
The rotator cuff is a group of four muscles that control your shoulder’s stability and ability to rotate. Rotator cuff tears can result from trauma to the shoulder, or from years of repetitive reaching and lifting. They commonly occur in people ages 50 and older, while partial tears are common among younger athletes who participate in overhead and throwing sports such as swimming, baseball, and tennis.
When to Seek Treatment for Rotator Cuff Tear
Shoulder pain that disturbs your sleep or makes it hard to perform daily activities -- such as getting dressed or simply lifting your arm overhead -- should be evaluated by an orthopaedic surgeon who specializes in the shoulder joint. Your doctor will use a variety of imaging tests, including X-ray, MRI, and ultrasound imaging, to evaluate the severity of your tear and determine the best course of treatment.
When to Consider Rotator Cuff Surgery
Surgery to repair the rotator cuff tear may be recommended if:
- Your shoulder pain continues despite non-surgical treatments
- You have a complete tear (not a partial tear)
- You are an athlete who wants to return to a high level of performance
Most rotator cuff surgeries are performed using an arthroscope, a tiny camera that is inserted through small incisions into the shoulder joint. Shoulder arthroscopy may be performed to diagnose or repair the rotator cuff tear. This minimally invasive approach results in less pain than other methods. Traditional open surgery, which requires large incisions, may be recommended when the tear is large or complex.
ROTATOR CUFF TEARS
Rotator cuff tear treatment depends on several factors, including the severity of the tear, your age, and your activity level. Whenever possible, your doctor will recommend non-surgical options first.
Steroid injections into the shoulder joint can reduce inflammation and relieve pain.
Specific exercises and stretches can improve your shoulder function. Duke has physical therapists on staff who specialize in shoulder injuries. They focus on exercises that strengthen your shoulder muscles, relieve pain, and restore movement. Our physical therapists can also tailor exercises to help you return to -- and possibly improve -- your sports performance. You will also learn to adopt new habits to reduce your chance of re-injury.
Both of these emerging therapies involve harvesting specific types of cells from your body, concentrating them, and injecting them directly into the painful or injured joint. While they’re considered safe, their benefits have not yet been proven, and they remain under study. Insurance generally does not cover them.
ROTATOR CUFF TEARS
Whenever possible, shoulder arthroscopy is performed using small incisions to reduce your pain. Traditional, open shoulder surgery may be recommended for extensive tears or when shoulder replacement is needed.
The surgeon reattaches a completely torn tendon to the top of the upper arm bone. A partial tear may be repaired by trimming or smoothing the rotator cuff. This procedure is called a debridement.
Large rotator cuff tears can be repaired using a piece of tissue, known as a graft. The additional layer reinforces the repair by thickening and strengthening the tendon.
Tendons that are too damaged to reattached can be replaced with a tendon from another location near the shoulder. During this procedure, one end of the transferred tendon is detached from its original position and relocated to the appropriate place. This allows the new tendon and its muscle to move the arm.
This newer procedure restores motion and relieves pain when severe rotator cuff tears can’t be repaired. The shoulder surgeon inserts a tissue graft that attaches from the ball to the socket of the joint. It doesn’t replace the rotator cuff, but it performs the same function, restoring the shoulder’s motion and stability.
When the rotator cuff is torn beyond repair and accompanied by arthritis, reverse shoulder replacement may be the best option. In this approach to shoulder replacement surgery, the ball and socket portions of the shoulder joint are reversed: A ball is attached where your shoulder socket normally sits, and a socket is fitted to the top of your upper-arm bone. This allows you to use muscles other than the ones in the rotator cuff to move your arm.