Rotator Cuff FAQs

Patients with involvement of rotator cuff have difficulty in doing overhead activities or lifting weight. They may also have difficulty in reaching out or reaching to their back. These patients also have considerable discomfort and awakening in the night due to the involvement of the shoulder. Confirmation of a rotator cuff tear can only be done with an MRI, but the physical examination as well as history is very suggestive in the diagnosis of a rotator cuff tear.

Most of the patients have a degenerative rotator cuff in which they may have pain over a long period of time before the onset of sudden or gradual exacerbation of the pain, which may or may not be associated with a sudden trauma. When the pain worsens, they may also have difficulty in reaching overhead things or doing overhead activities along with nighttime pain and discomfort. Occasionally patients may have a traumatic rotator cuff tear, which is more common in younger patients. These patients will have an episode of trauma like fall or accident, which may cause a traumatic tear of the rotator cuff by impinging it against the bone above. These patients will have sudden onset of severe pain, which may or not be associated with black or bluish discoloration of the skin. These patients will also have pain and discomfort along with weakness in the form of inability to perform overhead activities as well as reaching back.

Occasionally, patients may have a traumatic rotator cuff tear, which is more common in younger patients. These patients will have an episode of trauma, like fall or sudden injury, which may cause a traumatic tear of the rotator cuff by impinging it against the acromion. These patients may have sudden onset of severe pain, which may or may not be associated with black or bluish discoloration of the skin. These patients will also have nighttime pain and discomfort along with inability to perform overhead activities as well as reaching back.

Initially, patients can take over-the-counter pain medications and anti-inflammatory medications, like Aleve, Advil or Tylenol. If the patient has no relief, they should see a physician who may give them a Medrol Dosepak or cortisone injection in the rotator cuff. But if a patient has severe pain, these patients may need to be investigated further to find the cause of the pain, and if they are found to have a rotator cuff tear, they may need to undergo surgical repair of the rotator cuff.

Cortisone injections in the long term especially if given more than 3-4 per year do have detrimental effect on the muscles, tendon as well as bone and articular cartilage. Patients who are planned to undergo surgery in near future should avoid cortisone injection.

A surgery for the rotator cuff tear involves looking in and around the shoulder using arthroscopic methods in which the surgeon inserts a camera with light on it through poke holes and examine the shoulder. Once they find that the tear, using surgical instruments in the form of bone burrs and shavers, the insertion site for the rotator cuff tendon is prepared and the cuff is attached back to the bone using sutures and anchors. There are multiple techniques and methods to do the same. During the surgery, the cause for the tear may also be found to be bone spurs, which are cleaned up so that they do not dig in further and cause a re-tear.

Most often, the rotator cuff tears are caused due to impingement or digging in by the bone spurs on the bone above the rotator cuff. The bone spurs are formed due to age, as well as activity. These bone spurs tend to dig into the rotator cuff, especially while using the shoulder for repetitive heavy lifting, overhead activities. There may be spurs from the clavicle, which may also cause pain. Occasionally, the patient may have traumatic event, in which the rotator cuff is impinged between the head of the arm bone and the bone above and may cause a traumatic rotator cuff tear.

Rotator cuff tears do not heal by themselves, but Small tears may not be as symptomatic as bigger tears are. These cuff tears can be treated without surgery if a patient does not have much symptoms. These patients will specifically be helped by medications, cortisone injection and physical therapy, in which the aim is to strengthen the muscles and control the pain. If the patient is not improved with physical therapy, and has deterioration with regards to pain, range of motion, as well as strength, then this patient should see a sports physician to get further treatment.

A rotator cuff is formed by assimilation of tendons, which are wrapped around the head of the arm bone, also called humerus. These tendons are formed out of muscle bundles, which arise from the shoulder blade, or the scapula. These tendons pass between the head of the humerus and the bone above, called the acromion process of the shoulder blade. There is a significant space in which the rotator cuff can easily glide and carry out the movements needed in raising the arm or turning it in and out. It is only when the space is decreased, which may happen in the form of bone spurs on the acromion, that the tendon gets pinched between the two bones and may build up inflammation in the form of tendonitis or tear causing pain and weakness in all these actions.

A painful rotator cuff usually needs treatment in the form of medications, possibly a steroid injection, physical therapy, and if there is no relief with any of these, then a surgical intervention. If the patient keeps on using his shoulder regularly, despite the rotator cuff, there is a good chance that the rotator cuff will increase in size and cause further problems.

If a rotator cuff tear is causing significant symptoms, which are affecting the activities of daily living, recreation, and/or work, then the patient needs to see a physician for treatment. The treatment can be in the form of non-operative means like physical therapy, anti-inflammatory medications, with or without cortisone injections. If the patient has no relief at all with these non-operative means, then he may need a surgical intervention in the form of repair to take care of his pain and other symptoms.

Patients who have a suspected rotator cuff tear will have pain in the shoulder, specifically in carrying out activities like lifting, overhead activities, reaching back, or reaching out. These patients will also have pain in the night, with or without awakening. These patients may also complain of restriction of movement. An examination of the physician will help learn from the findings. Confirmatory diagnosis of the rotator cuff tear can be made by an MRI and can also be found from the arthroscopic examination of the shoulder blade.

The rotator cuff muscles arise from the shoulder blade and, when they near the head of the arm bone of the humerus, they form a tendon cuff, which is called the rotator cuff. This cuff gets attached over a wide area onto the head of the humerus, wrapping it all around, the front, upper part, and the back of the head.

The 4 rotator cuff muscles are medically named as: Subscapularis, Supraspinatus, Infraspinatus, and Teres minor. They all wrap around the head of the arm bone, or the humerus, to form the rotator cuff and its insertion.

Patients with rotator cuff tendinitis and no tear usually gets better in about four to six weeks. They will improve gradually with medications, cortisone shot, and physical therapy. Some patients with a high-grade tendinitis or partial tears may take longer time to recover from the pathology.

Overhead abduction and outwards and inwards rotation may cause more pain, and rather the patient may have inability to perform these movements. These exercises may cause exacerbation of the pain and should be avoided. Once the surgery for rotator cuff tear has been performed, a specific protocol of exercises as well as limitations is informed to the patient by the physician as well as the physical therapist, which should be rigorously followed.

After the rotator cuff surgery, the shoulder is put in a shoulder sling and the patient is advised not to use it for one to three months depending on the size of the tear and the surgery done as well as the recovery and rehabilitation. In case of larger, massive tears, this could take up to three to five months before the patient is able to use the arm in a usual fashion. A well performed surgery with full healing can have complete recovery from rotator cuff tear and the patient may be able to use the shoulder as before the tear. In case of larger, massive tears there may be partial recovery because of the profound damage to the rotator cuff tear and in such cases, the result may be regarded.

The alternative treatment for arthroscopic rotator cuff tear are physical therapy, cortisone injection in the shoulder, anti-inflammatory medications. These treatment modalities though do not cause healing of the rotator cuff tear, but they cause short term pain relief.

If the patient decides to defer the surgery, the tear does propagate over time though slowly. If needed, the operation can be delayed, depending on the symptoms and patient’s requirements. The patient will have restriction of activity due to pain and weakness with episodic exacerbations.

Most patients the arthroscopic rotator cuff tear repair are sent home within a couple of hours after the surgery. They are given a nerve block which gives good pain relief for next 24 hours approximately. Patients are also provided with pain medication prescription to control pain.

A rotator cuff tear surgery operation usually lasts about 2 to 3 hours. Patients with complex and large tears may need more time for their surgery. Patients are usually sent home in couple of hours after the surgery.

Patients are given nerve block in to numb the arm and the shoulder. This is helpful because this gives good pain relief in the post-op period, almost up to 24 hours after the surgery. Patients are also given general anesthesia during the surgery to augment the pain relief.

Patients with torn rotator cuff have difficulty sleeping because of the pain. They may have difficulty going to sleep as well as have multiple awakenings. They should try sleeping in a reclined position with the help of multiple pillows to support the shoulder. Patients are usually not comfortable sleeping on the involved shoulder, but they can try sleeping with the involved shoulder up.

Occasionally a rotator cuff tear can cause referred pain up along the neck, or the back, or the front of the chest, or even into the arm. Their history, as well as physical examination done by a physician, may be suggestive of a rotator cuff tear. If the diagnosis is not confirmed, then an MRI of the shoulder may be done to confirm the diagnosis. Occasionally patient may have a pinched nerve in the neck as well as a torn rotator cuff, and a judicious diagnosis plan as well as treatment plan is needed for such patients.

Most of the rotator surgeries are done as an outpatient, in a hospital or ambulatory surgery setting. The patients are usually discharged within a couple of hours after the surgery along with the shoulder sling, pain medications and other medications.

Partial tears can be given a chance to be treated without surgery, with the use of anti-inflammatory medications, steroid injections, and physical therapy, and may heal by itself. If the patient does not get better with these modalities, then they may need surgical treatment for the management of the torn rotator cuff.

A full thickness tear is another word for a complete rotator cuff tear. The partial tears are incomplete tears and they may be either on the upper or the lower surface of the rotator cuff, depending on the site of pathology.

The treatment of rotator cuff injury usually starts with a conservative management in the form of anti-inflammatory medications, rest followed by physical therapy, with or without steroid injection. If the patient does not get better with these, or if the patient history and examination is suggestive of a rotator cuff tear, then an MRI may be needed to confirm the diagnosis and patient may need surgical treatment for the same.

Occasionally, patients may have a traumatic rotator cuff tear, which is more common in younger patients. These patients will have an episode of trauma, like fall or sudden injury, which may cause a traumatic tear of the rotator cuff by impinging it against the acromion. These patients may have sudden onset of severe pain, which may or may not be associated with black or bluish discoloration of the skin. These patients will also have nighttime pain and discomfort along with inability to perform overhead activities as well as reaching back.

Patients with desk-type jobs can return to work in two to four weeks depending on the side involved being dominant or not, as well as their work demands, the use of both upper extremities or not. Patient will have to keep his operated side in a sling till the doctor and the physical therapist release them, which may take up to two to three months. If the patient is involved in heavy work in which he must perform lifting of objects or doing overhead activity, they will need to be out of work for three to five months depending on the size of the tear and the surgery performed.

Rotator cuff repair surgery is a major arthroscopic surgery of the shoulder joint. It takes about 1-1/2 to 2-1/2 hours depending on the size of the cuff and the additional procedures performed. The patient is usually operated in an ambulatory daycare surgery setting and are sent back home within couple of hours after the surgery. It usually takes 3-5 months for recovery from rotator cuff repair surgery.

After the rotator cuff surgery, it is expected to have some pain in the shoulder, as well as swelling and black or bluish discoloration of the skin, due to leakage of blood along the arm and occasionally to the forearm. Besides the risks of anesthesia for surgery, there is a very small risk of infection, injury to nerve and vessels, stiffness of the joint. Patients also have a small chance of stroke, blood clots, heart attack, paralysis and death.

After the rotator cuff repair surgery, patients must work with a physical therapist for their rehabilitation. It usually takes from 2-5 months to regain full range of motion and strength, depending on the size of the rotator cuff tear and the procedure performed.

Patients who undergo rotator cuff repair surgery need to work with physical therapist to regain their range of motion as well as strength. Once the patient can perform active range of motion and strengthen of these muscles, then the patient is allowed gradually increasing lifting of weight and limiting of restrictions. It usually takes 3 months for a tear to heal. It will take longer in patients who have systemic chronic diseases or tears or in smokers.

The decision for a surgery for a rotator cuff repair is made after discussion between the patient and the physician. The patient may decide not to get surgery done and, in such case, they may decide to be treated conservatively in the form of anti-inflammatory medication, cortisone injections, and physical therapy. These patients will usually get a little better with all these management, but there may be deterioration over time due to decreasing effect of the medications, as well as chances of worsening of the tear. Patient can, later, decide to undergo surgery once they feel that they have failed all of the conservative measures for the management of the rotator cuff tear.

Depending on the size of the rotator cuff tear as well as the surgery performed, patient may have to wait for four to 12 weeks before they are able to drive. They should be in contact with their physician as well as physical therapist and follow their recommendations with regards to increasing their activity as well as driving.

The rotator cuff surgery pain is more on the second day of surgery after the effect of the brachial block weans off. Patients are given pain medications to control the pain. It may take three to five days for the severity of the pain to decrease. Most of the patients can stop taking pain medications within two to three days and can manage their pain on anti-inflammatory medications after that. The pain in the shoulder gradually decreases over a period and may take about four to six weeks to almost stop completely. In these cases, also the patient will have exacerbation of pain after some activities, especially with physical therapy.

Patients can shower about 72 hours after the rotator cuff surgery. These patients usually have one or two stitches on three to five sites over the shoulder, and they can cover those sutures with Band-Aids at the time of shower. After the shower, they can dab the area dry and change the Band-Aids.

Patients who undergo rotator cuff surgery are put into a physical therapy program after the surgery. The time to start of physical therapy program as well as the duration depends on size of the tear. The patient must follow with a physical therapist as well as the physician with recommendations with regards to the limitations as well as activities. It may take up to three to four months to heal in case of high-grade and bigger tears.

The rotator cuff surgery is done under a nerve block in which the nerves to the shoulder are numbed so that there’s no pain during the surgery. At the same time, patient is also given some general anesthetic during the surgery. The block effect stays there for almost 24 hours after which the patient may have some pain in the shoulder after the surgery. Patient is provided pain medications to control the pain. The pain gradually improves over time.

Patients who undergo rotator cuff tear surgery need to attend physical therapy on recommendation of the treating physician. They may have to start physical therapy within 1-4 weeks after the surgery, depending on the size of the rotator cuff tear and the procedure performed. Patient may need to go to the physical therapist for 2-4 months, depending, on the size of the tear, the procedure performed, as well as recovery from the surgery. Patients are usually asked to be in physical therapy until they have attained almost 90-95% of their range of motion and strength without pain.

Patients who undergo rotator cuff tear repair surgery do need to wear a sling for 2-3 months after the surgery. The weaning out of the sling usually depends on the size of the tear and the type of the procedure performed, as well as recovery with the help of physical therapy. The recovery is slow in patient with large tears as well as in presence of chronic diseases like diabetes and in smokers.

Patients who undergo rotator cuff repair must undergo rehabilitation with a physical therapist. Once the patients are weaned out of their sling and have recovered near complete range of motion and strength in the shoulder, then they are put into post-rehabilitation program, in which they gradually work towards getting back to their pre-tear level of strength. The patients who want to go back to their usual recreational activity are also allowed to gradually start working towards the same goals.

Most of the patients with rotator cuff tear will have difficulty sleeping as well as have multiple awakening throughout the night. Patients are not able to sleep on the affected shoulder. Patients with tendonitis may also have similar involvement and should see a physician for management.

Rehabilitation with physical therapist is of profound importance in the management of rotator cuff tears. After a rotator cuff surgery, the patient must enroll into a rehabilitation program on physician’s advice, which may start one week to one month depending on the type and size of tear as well as the treatment done. Patient may need to be in the rehabilitation with physical therapist for three to five months.

Rotator cuff surgery is performed by orthopedic surgeons who are specialized in arthroscopic shoulder surgery. Arthroscopic surgeons are usually fellowship trained in sport surgery.

After the rotator cuff surgery, it is expected to have some pain in the shoulder, as well as swelling and black or bluish discoloration of the skin, due to leakage of blood along the arm and occasionally to the forearm. There is a risk of tingling, numbness, surgery site infection, sympathetic dystrophy, non-healing of the repair etc. Besides the risks of anesthesia for surgery, there is a very small risk of infection, injury to nerve and vessels, stiffness. Patients also have a small chance of stroke, blood clots, heart attack and rarely death.

If the patient has chest pain or stroke-like symptoms, they should immediately seek medical attention in the form of calling 9-1-1 or visit an emergency room. If the patient has worsening pain despite pain medications or discharge from the incision site or fever with chills, they should call their doctor’s office to discuss regarding the further management or visit emergency room or an urgent care center.

It depends on how much surgery has to be preformed.

You can’t know unless you go to the doctor who takes a history, does a physical exam and, if indicated, obtains an MRI. The doctor, after putting all that information together, will be able to tell you whether you have a rotator cuff tear.

It is associated with pain about the shoulder. It can travel into the arm

Keep the elbow by the side. Sleeping propped up will help.

If you don’t treat it, it can last for years. With treatment it can resolve. How long it takes depends on whether you get appropriate therapy and your healing ability.

Any exercises where your elbow moves out to the side or forward. The higher your elbow goes the harder it is on your rotator cuff.

Yes, as does any other exercise that overworks the shoulder.

It depends on what kind of work you do. If you don’t have to use the arm and you don’t have any associated upper back problem, you can go back in a sling once the postoperative pain subsides where you don’t need pain medicine. That could be 10-14 days. If you have to use your arm it could be a couple of months at least.

Yes

It depends on what kind of work you do. If you don’t have to use the arm and you don’t have any associated upper back problem, you can go back in a sling once the postoperative pain subsides where you don’t need pain medicine. That could be 10-14 days. If you have to use your arm it could be a couple of months at least.

It depends on what kind of vehicle you drive. If you drive a car where you can use primarily one arm using the operated arm to hold the steering wheel at the bottom, you can drive once you are off pain medication. If you have to drive a vehicle that requires using two arms, then that takes at least 2 months.

That depends on how much surgery was done. Anywhere from two weeks to longer.

Initially you are going to be unsteady because of the surgery and the pain medicine. So showering would be unsafe unless someone is helping you. Your wounds need to be kept dry until they are healed enough. That depends on what was done.

For the first two weeks you have to rest the arm keeping the elbow by the side doing wrist and elbow range of motion. After two weeks passive range of motion is began. Active range of motion of the shoulder is begun once the repair is healed enough to handle the muscle tension applied to it. This is usually around six weeks. How much active motion will vary depending on what was repaired and the condition of the muscle.

If the bursitis is due to the usual cause which is deconditioning of the muscles about the shoulder, then that can take several months of appropriate rehabilitation. You can get relief before then by keeping the elbow closer to the side within the pain-free range.

Tendinosis may be due to active healing or a consequence of healing. That means the tendon was and may still be exposed to abnormal loads. It means the shoulder needs to be continued on a appropriate exercise program.

It is associated with pain about the shoulder. It can travel into the arm.

Keeping the elbow by the side.

The most common cause is deconditioning of the muscles about the scapula. This results in the rotator cuff having to function in suboptimal positions.

A microscopic tear can. If it is big enough to be seen by the naked eye (i.e. at surgery) it can’t.

The rotator cuff is associated with a group of muscles attached to the shoulder blade. The tendons of these muscles go across the joint between the scapula and the top part of the arm bone, the humeral head, which is in the shape of a ball. The tendons attached to the outer side of the humeral head in front, on top and in back. They also connect to each other forming a continuous tendon going from the front, across the top and down the back of the humeral head. The tendon looks similar to a cuff of a shirt and is so-called the rotator cuff. The rotator cuff pulls and holds the humeral head in joint.

The most common cause is deconditioning of the muscles about the scapula and the tendons at their insertion on the humeral head. This results in the rotator cuff having to function in suboptimal situations. It presents with pain. To differentiate it from other causes of shoulder pain you would have to go to a doctor.

Yes

When it gets to be greater than 1/4 inch.

It is associated with pain about the shoulder. It can travel into the arm.

You can’t know unless you go to doctor who takes a history, does a physical exam and, if indicated, obtains an MRI. The doctor, after putting all that information together, will be able to tell you whether you have a rotator cuff tear.

It addresses the cause of the rotator cuff injury which is poor coordination of the movement of the shoulder blade and the arm and weakening of the tendon.

The rotator cuff is associated with a group of muscles attached to the shoulder blade. The tendons of these muscle go across the joint between the scapula and the top part of the arm bone, the humeral head, which is in the shape of a ball. The tendons attached to the outer side of the humeral head in front, on top and in back. They also connect to each other forming a continuous tendon going from the front of the shoulder, across the top and down the back of the humeral head. The tendon looks similar to a cuff of a shirt and is so-called the rotator cuff. The rotator cuff pulls and holds the humeral head in joint.

They are attached to the front, top and the back side of the scapula. Their tendons reach out and around the top part of the humerus, the humeral head. They attach around the outer part of the humeral head and pull it in and hold it in the socket.

Supraspinatus, infraspinatus, teres minor and subscapularis.

Most commonly it is due a combination of weakening of the tendon at or near the bone tendon junction and poor coordination between the scapula and arm motion.

To hold the humeral head in the socket. It also moves the humerus.

Make sure you are on a good shoulder rehabilitation program. Be careful when using your arm overhead.

The tendon of the rotator cuff is reattached back to the bone where it was originally attached. It is done either arthroscopically or through an open incision. The choice depends on what has to be done to reattach the tendon.

Usually 3 times a week for several months.

Depending on the size of the repair, it could be 4-6 weeks.

You won’t be able to return to sports until you have full strength and motion of your shoulder. That could be 3-4 months. You can begin lower extremity conditioning once you have no pain off pain medicine. It should be an activity where you are sitting or lying to minimize the risk of falling and reinjuring your shoulder.

That varies with each individual. Usually 4 weeks.

Once the tendon is healed. That is usually about 6 weeks. You will have to start with low weight in restricted ranges. As you get H2er you will be able to lift farther out to the side, in front and overhead.

It depends on the size of the tear and how you take care of it. Very small tears can heal with good shoulder rehabilitation. Big tears won’t heal. They may progress in size. The detached muscle will atrophy. Over time it will atrophy to the point where it will no longer be able to function .

Persistent pain, stiffness, muscle weakness.

Rotator cuff pain is frequently worse at night. This can be improved by not using the arm during the day and sleeping upright at night.

It is essential.

To restore normal function of the shoulder.

An orthopedic surgeon.

Persistent pain, stiffness, muscle weakness.

Doing a course of shoulder rehabilitation before surgery will help.

Yes. The pain is generally well controlled using medication.

If you are having any kind of pain that has not gone away after days to a week, call your doctor.

Immediately postoperatively you won’t be doing much more than sitting and taking your pain medicine. As the pain improves you will gradually be able to do more. You won’t be able to use your arm until the repair has healed.

Best source is the internet.

Best source is the internet.

Check the internet.

Persistent pain, stiffness, muscle weakness. It varies with the individual.

If you do everything you are supposed to you should get a lot of improvement.

Persistent pain and weakness.

You can limit use of your shoulder and follow a good rehabilitation program.

The longer the muscle tendon is unattached the more the muscle will atrophy. The more the muscle atrophies the longer it takes to come back if it is able to come back at all. The longer you wait the longer the recovery and the worse the outcome.

Frequently it is done as an outpatient.

It varies depending on the extent of the tear.

Frequently a block with sedation.