Shoulder pain is one of the most common problems that I see. Many patients present with an acute onset of pain and know exactly how the pain started, such as the patient who is lifting weights in the gym and feels a ripping sensation in the front part of his shoulder. Other patients may have a more insidious onset of pain; it wakes them from sleep, overhead activity is painful, but in general, they can’t remember the day it started.
Either of these scenarios may represent a rotator cuff tear. We think of damage to the rotator cuff in terms of acute trauma, or often in terms of “wear and tear over time”.
As I recently read over all of the current articles written about the cause of rotator cuff tears, one of the interesting findings is that there is no scientific proof to the “wear and tear over time” theory. There is a strong association of rotator cuff tears with a single event of trauma, male gender, dominant arm, the older age of the patient, and finally, the shape of the shoulder blade overlying the rotator cuff. This latter factor we call “acromial morphology”. If there is a bone spur or hook on the front of this acromion, it is believed to put more pressure on the rotator cuff and mechanically contribute to the development of a rotator cuff tear.
Finally, anything that causes a decrease in blood flow to the area of the rotator cuff attachment to the bone can contribute to the development of a tear. Smoking is one of these factors.
The reality is the development of most rotator cuff tears is multi-factorial, with many of these factors, and presumably some others, becoming together with the final cause. Not only is the identification of “cause” of rotator cuff tears elusive, but the ideal treatment can also vary from patient to patient. I have seen occasional patients with large rotator cuff tears who had excellent motion and minimal to no pain and were ultimately happy with non-operative treatment.
However, the majority of patients with rotator cuff tears, small or large, do best with a rotator cuff repair. The gold standard treatment is an arthroscopic rotator cuff repair using suture anchors to tie the rotator cuff down to the bone. This is done through small incisions around the shoulder which aids in rehab and decreased pain. Other pain-relieving tools we use are an interscalene block which numbs up the shoulder before and after surgery, making the experience typically much better.
If the rotator cuff tear has been present for a long period of time, arthritis may set-in and the rotator cuff becomes irreparable. Depending on the age and other factors, these patients may be a candidate for a specialized shoulder replacement called a reverse total shoulder replacement.
So, whether it’s sudden onset of pain in the shoulder from lifting weights or a slower onset over a long period of time, it may be time to get that shoulder checked out. With a minimally invasive arthroscopic approach, we plan to help you get back in the game.