Signs and Symptoms
Rotator cuff tears do not always hurt, especially tears that develop slowly with age. When they do cause symptoms, you may notice:
- A dull ache deep in the shoulder or down the outside of the upper arm
- Pain at night, especially when you lie on the affected side
- Weakness when you lift or rotate your arm, such as reaching overhead or behind your back
- A crackling or catching feeling when you move the shoulder
- Sudden pain and inability to lift the arm after a fall or a heavy lift
What Causes It?
There are two main causes. An acute tear happens with an injury, such as falling on an outstretched arm or lifting something heavy with a jerking motion. A degenerative tear develops gradually as the tendon wears down over time.
Your risk rises with age, particularly after 40, and with repetitive overhead work or sports such as tennis, swimming, painting or carpentry. Bone spurs and reduced blood supply to the tendon with age can also play a part, and shoulder impingement (pinching of the tendons under the bony roof of the shoulder) can contribute to wear.
How We Diagnose It at POPB
Your physician will ask how the pain started, check your strength and range of motion, and perform specific tests that isolate each rotator cuff tendon.
Imaging is done in our office. X-rays look for arthritis and bone spurs. Diagnostic ultrasound can show many tears during the same visit, and MRI, also available on site, shows the size of a tear, how far the tendon has pulled back and the health of the muscle. Having imaging under one roof usually means fewer trips before you have a plan.
Non-Surgical Treatment Options
Many partial tears and some full-thickness tears in less active or older adults improve enough with non-surgical care to allow comfortable daily activity. Options include:
- Rest from the motions that aggravate the shoulder, plus ice and anti-inflammatory medication if appropriate for you
- Physical therapy in our office, focused on strengthening the remaining rotator cuff and shoulder blade muscles. Our therapists share your chart with your physician.
- Cortisone injection, sometimes guided by ultrasound, to calm inflammation so you can do therapy
- PRP (platelet-rich plasma, prepared from your own blood) for selected patients. Evidence is still developing, results vary, and insurance usually does not cover it.
Surgical Options
Surgery may be recommended for large or acute tears in active people, for tears that cause significant weakness, or when several months of non-surgical care has not helped. Waiting too long on some full-thickness tears can allow the tear to grow or the muscle to weaken, so timing is something to discuss with your surgeon.
Dr. Chalal and Dr. Wolfson perform arthroscopic rotator cuff repair, in which the surgeon uses a small camera and small incisions to reattach the tendon to the bone with anchors. In shoulders with advanced arthritis and a tear that cannot be repaired, a shoulder replacement may be discussed. Our surgeons operate at area surgery centers and hospitals, and most rotator cuff repairs are outpatient procedures.
Recovery
Recovery from rotator cuff repair takes patience. You typically wear a sling for about 4 to 6 weeks, start gentle guided motion early, and begin strengthening around 2 to 3 months after surgery. Many people return to most daily activities in 4 to 6 months, and full strength can take 6 months to a year. Timelines vary with the size of the tear, the quality of the tissue and your overall health.
Your physical therapy can happen in our office, where your therapist works directly with your surgeon on each stage of the plan.
Insurance and Cost
Office visits, imaging, physical therapy, cortisone injections and medically necessary surgery are generally covered by Medicare, most commercial PPO plans and workers' compensation, subject to your deductible and co-pay. If you have an HMO or managed-care plan, a referral from your primary care physician must be in our office before your visit.
PRP is usually not covered by insurance. If your shoulder was injured on the job, we coordinate care and documentation with your employer and carrier.
When to Be Seen
Make an appointment if shoulder pain lasts more than a few weeks, wakes you at night, or comes with weakness when you lift your arm. If you suddenly cannot raise your arm after a fall or injury, call our office promptly, because acute tears can do better when they are evaluated early. If you have an obvious deformity after a fall, go to the emergency room.
