Your rotator cuff is an integral part of your shoulder—helping stabilize the shoulder by holding the ball (humerus) and glenoid socket (scapula) together as you raise and rotate the arm. When the rotator cuff is torn and not functioning properly, shoulder weakness and pain is the result.
In this article, the Dr. Robert Rolf at Beacon Orthopaedics discussed common questions asked about the rotator cuff and rotator cuff tears.
How does the rotator cuff tear, and how do you know you’ve sustained a tear?
Rotator cuff tears can happen at any age, but are more common as we get older.
As you shoulder moves, the rotator cuff keeps the humeral head of the shoulder depressed into the glenoid socket. If the humeral head does not stay within the glenoid socket, it will elevate and hit underneath the acromion, the outside part of the scapula, and result in impingement. Impingement leads to bursitis (inflammation in the bursa) and tendinitis (inflammation in the tendon). This will ultimately result in partial then full-thickness rotator cuff tears. Clinically, people will start experiencing pain and weakness.
Athletes who play sports that require a lot of overhead activity are at a high risk for sustaining a rotator cuff tear. These tears can result from a single traumatic event—such as a sudden fall on your shoulder or a collision with an object or another player—or the tears can develop gradually because of repetitive overhead motions like pitching or throwing a ball.
One way to know that you’ve sustained a tear is through the following test:
- Sit yourself comfortably in a chair.
- Bend your elbow 90 degrees.
- Tuck your elbow into your side.
- Have someone push your hand in towards your belly as you try to push out.
If you are unable to hold that position and/or feel pain while trying to keep your arm in that position, you may have sustained a rotator cuff tear and should schedule an appointment to get a consultation.
What does it feel like to have a torn rotator cuff?
Common symptoms include:
- Vague pain in the front of your shoulder
- Pain that radiates down the side of your arm
- Recurrent pain with overhead activity
- Night pain that awakens you from sleep
- Weakness (especially when attempting to lift your arm)
- Loss of range of motion
- Difficulty raising the arm away from your side by yourself
- Catching or snapping sensation when you move your arm
Do rotator cuff tears heal on their own? How do you fix a rotator cuff tear?
Many times, rotator cuff tears can be treated with conservative methods such as anti-inflammatory medication, steroid injections, and physical therapy. If the tear is complete, meaning that there are no longer any fibers attached to the bone, it is likely that your rotator cuff will not heal on its own—in these cases surgery is recommended.
Conservative treatments and surgical treatments alike are designed to restore strength, functionality, and mobility to the involved shoulder and relieve your shoulder pain. Your orthopedic surgeon will help you decide the best plan of action for your shoulder.
What is the average recovery time for rotator cuff injuries?
In majority of the recovery can take 4 to 6 months or longer, depending on the size of the tear. Most activities can be resumed at 6 months, however the rotator cuff will heal for up to a year.
How important is rehabilitation in the treatment of a rotator cuff tear?
Rehabilitation plays a critical role in recovery—no matter if you are choosing nonsurgical or surgical treatment options. Proper rehabilitation to strengthen your rotator cuff muscles and your periscapular muscles will decrease her overall recovery time and help you reach your maximum function.
If surgery is the best solution for your tear, you may have to wear a sling for four to six weeks after surgery. Most people are involved in physical therapy for 3-6 months after surgery. Over time, you go to physical therapy less frequently, but continue to do a home based program.
Your orthopaedic surgeon can talk through your options with you at length to discover the best program for you, based on your needs.
What positions should I rest my arm in after surgery?
Not all rotator cuff repairs are the same and a physician may modify your postoperative care based on what was done during surgery. Most repairs are placed in a sling with a pillow to wedge the arm away from the body and take some tension off the rotator cuff repair.
During the first stage of rehab, which may last up to 6 weeks, you will not be able to move your shoulder on your own. Your physical therapist we will move your shoulder for you and may even help you set up a pulley system at home to continue this passive motion. If you try to actively move your shoulder before the tendon is healed, you may disrupt the repair.
When resting, many people find it more comfortable to prop up in bed with a pillow behind the shoulder. Some people even prefer a recliner. Both of these options seem to be more comfortable than lying flat in bed.
Are there differences between an open and arthroscopic rotator cuff repair?
Arthroscopic repair is done through small portal incisions and is the most common way that rotator cuff tears are fixed. Some tears require a larger incision. While the incision sites look smaller with an arthroscopic procedure, it is important to remember that the same tissues were still repaired and thus the same postoperative precautions regarding tissue-healing time for repaired muscle/tendon are observed.
When to Talk to a Shoulder Specialist
If you’re concerned that you may have sustained a rotator cuff tear, and exhibit any of the symptoms listed in this article, or have been having difficulty moving your arm, schedule an appointment with Dr. Rolf.