Rotator Cuff Tears
The shoulder joint consists of the humerus (arm bone), the glenoid (part of the scapula bone), the labrum, and the surrounding tendons and ligaments. The humeral head sitting in the glenoid can be thought of as a “golf ball on a tee” because of the large humeral head and small labrum. As a result, the shoulder has a very large range of motion, but in exchange loses stability and is easily injured or dislocated. The four most important muscles and tendons that surround and stabilize the shoulder are the rotator cuff muscles: supraspinatus, infraspinatus, teres minor, and subscapularis. These muscles are covered by a bursa that helps lubricate the tendons and allow them to glide freely during motion. Together, these muscles with the help of the labrum, a ring of cartilage around the glenoid, hold the humeral head into the shoulder “socket” and stabilize the shoulder. It is important to recognize that unlike other joints that have strong bone and ligament stabilizers, the shoulder is primarily stabilized by muscles and tendons.
Rotator cuff tears are common, and occur when one or more of the rotator cuff tendons becomes detached from the head of the humerus. The most common tear is in the supraspinatus tendon, but any of the four tendons can be involved. Rotator cuff tears can either be partial (incomplete) or full thickness (complete). A partial tear is still attached to the humeral head, but a full-thickness tear typically leaves a hole or a gap in the tendon. Rotator cuff tears in young individuals are generally acute tears that occur from a single traumatic event, such as a fall or accident. However, most rotator cuff tears are the result of degenerative fraying and weakening of the tendon over time. There are many causes for generative tears, and there is a greater risk for these to be bilateral (both sides) and to recur.
About half of patients with rotator cuff tears respond very well to treatment with the RICE protocol (rest, ice, compression, and elevation). Avoiding the exacerbating activity is the first and most important step. Drugs such as ibuprofen and aspirin can help reduce pain and swelling. In addition, rehabilitation with strengthening and physical therapy can often improve symptoms and enhance recovery. Lastly, your doctor may suggest a steroid injection to reduce inflammation, which can often relieve pain.
In some cases, when non-surgical treatment has not been able to relieve pain and improve symptoms, your surgeon may recommend a rotator cuff repair. There are numerous ways to repair the rotator cuff, but most are performed either completely or partially with arthroscopic surgery using small cameras and tools placed inside the shoulder. Speak with your surgeon to understand his or her preferred treatment options.
Your physician will recommend a specific rehabilitation protocol to enhance your recovery to activities and decrease pain after surgery. The importance of physical therapy in the shoulder cannot be overstated since it is the muscles and tendons that primarily stabilize the joint. Exercises will consist of exercises for improving strength, maintaining motion, and re-training your muscles during the recovery phase. These exercises will typically progress in stages as the tendon heals and gets stronger. It is important to follow the protocol exactly as your surgeon recommends since going to fast may result in injury to the surgical repair and going too fast can result in stiffness and decreased motion. Exercises should be performed in a supervised setting, as well as at home on your own time. Your commitment to rehabilitation is key to a successful outcome.