Rotator Cuff Tears

Rotator Cuff Tears

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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 specialists evaluate the severity of your rotator cuff tear to determine if you will benefit from nonsurgical approaches and physical therapy or shoulder surgery. Our goal is to alleviate your shoulder pain and return your shoulder strength and function, so you can get back to the activities and sports you enjoy.

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When to Seek Care for Rotator Cuff Injuries

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. Partial tears are common among younger athletes who participate in overhead and throwing sports such as swimming, baseball, and tennis.

When to Seek Care
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.

  • Orthopaedic Care Within 24 Hours
    In many cases, an orthopaedic provider may see you the same day you call for an appointment or within the next 24 hours.

  • Visit Duke Orthopaedic Urgent Care
    Our convenient orthopaedic urgent care locations in Durham and near Cary and Morrisville are open seven days a week. Get fast service with no long waits and no unnecessary exposure to sick people.

Is Shoulder Surgery Necessary?
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

Duke Orthopaedic Clinics

Duke Health orthopaedic clinics are located in Durham, Raleigh, Cary, and other locations throughout the Triangle.

Nonsurgical Treatments

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 nonsurgical options first.

Joint Injections

Steroid injections into the shoulder joint can reduce inflammation and relieve pain.

Physical Therapy

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.

Platelet-Rich-Plasma (PRP), Stem-Cell Therapy

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.

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Rotator Cuff Surgery

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 or when shoulder replacement is needed.

Rotator Cuff Repair

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.

Rotator Cuff Repair Augmentation with Graft

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.

Tendon Transfer

Tendons that are too damaged to be 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.

Superior Capsular Reconstruction

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.

Reverse Shoulder Replacement

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.

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Reviewed: 02/15/2018