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Do You Have a Rotator Cuff Tear?

If you’re over the age of 30, there is a greater than 30% chance that you have experienced some form of shoulder discomfort at some point. It’s a shared experience among all individuals, whether it’s a momentary twinge from a sudden pull or a fall, or a persistent, nagging ache that seems to linger.

Shoulder pain isn’t limited to athletes; anyone can experience it. Following back pain, shoulder pain stands as the most prevalent musculoskeletal complaint seen by healthcare professionals in the U.S. Over 6 million individuals in the U.S. seek medical attention for shoulder pain annually. Of these, over 30% are related to the rotator cuff, with around 1 in 7 rotator cuff issues eventually requiring surgery.

This common occurrence of shoulder pain, particularly related to the rotator cuff, is attributed to the unique anatomy of our shoulder joints, which possess the greatest degree of mobility in our body. This exceptional mobility permits our ability to position our hands virtually anywhere in space, whether it’s reaching for a grocery bag at the back of a car seat or screwing in a high-ceiling light bulb. However, this heightened mobility comes at the cost of increased inherent shoulder instability.

Unlike the hip joint, which possesses a deep bony socket for structural support, shoulder joint support is completely reliant on the rotator cuff muscles. The rotator cuff is made up of four muscles originating from the shoulder blade (scapula) and extending towards the upper arm (humerus), resembling the outstretching legs of an octopus. The four rotator cuff muscles merge together as a tendinous complex, moving as one functional unit to accommodate changes in arm position and directions of motion. The rotator cuff complex must harmoniously contract and stiffen to maintain the shoulder joint’s centered alignment during arm movements and prevent shoulder dislocation.

The demanding nature of maintaining this delicate equilibrium between flexibility and stiffness places significant strain on the rotator cuff.

Rotator cuff tendon pathology manifests in a spectrum of presentations, just as the various changes seen in the fabric of a pair of worn-out jeans. This spectrum may exhibit the gamut from subtle surface discoloration and mild fraying to minor separations, extending all the way to frank tears and separations. The tears can come about as an acute nature or manifest as an acute-on-chronic condition. More commonly, they evolve as a consequence of a gradual degenerative process.

It is anticipated that about 50% of the healthy population, upon reaching the age of 66, may spontaneously exhibit radiographic signs of shoulder rotator cuff tendon tears, even though the symptoms may differ widely. It’s noteworthy that statistically, nearly all instances of these complete, full-thickness rotator cuff tears are only seen in individuals aged 40 and above. For those younger than 40, complete full-thickness tears usually occur from a sudden catastrophic traumatic event, as opposed to those over 40 who exhibit, over time, these evolving ‘spontaneous’ wear-and-tear changes.

The most common symptoms of full thickness rotator cuff tears are :

1) Shoulder pain while sleeping on the affected side.

2) A history of recurrent episodes of shoulder “tendinitis” or “bursitis”. Periods of rest, use of anti-inflammatory medications, or even cortisone injections might have initially alleviated the discomfort; however, these episodes of shoulder pain progressively increase in frequency, duration, and intensity, such that these measures of rest and medication are no longer helpful.

3) Shoulder pain and weakness when attempting overhead arm movements or when encountering resistance, particularly pronounced with arm external rotation: such as when attempting to slip the arm into a jacket sleeve.

Treatment approaches vary widely. Not all individuals with rotator cuff tears necessarily undergo surgery. The decision-making process involves numerous factors. Among these, a primary consideration is the level of discomfort. Factors such as frequency, intensity, and circumstances surrounding the pain play a central role. Additionally, personal willingness to endure the symptoms and make lifestyle adjustments in exchange for symptom reduction is crucial.

General health status is another significant aspect, along with the readiness to assume potential risks and complications associated with surgical intervention. It’s important to acknowledge that secondary surgeries might be necessary if the initial repair doesn’t heal as expected. Defining your goals and expectations is key.

Nonetheless, it’s vital to recognize that surgery isn’t a universal remedy, and an appropriate treatment approach can only be determined through comprehensive discussions with the treating surgeon. Each individual’s situation is unique, and variations tailored to each person’s needs and expectations must be carefully considered.

Despite technological advances and improved surgical techniques, regrettably, the success rate for rotator cuff repairs to fully heal after surgery ranges from a paltry 10% to as high as 90%. These challenging numbers are rooted in the intricacies of the healing process. Broken bones mend consistently because they engage in bone-to-bone healing. Similarly, torn muscles heal reliably as muscle-to-muscle healing occurs when they are sutured together. Even in cases where tendons are torn in the tendon structures themselves only, like in sewing together a mid-substance Achilles tendon tear, they manage to heal, as tendon is sewn to tendon. However, difficulty arises when trying to reattach the torn rotator cuff tendon to bone. This calls for tendon-to-bone healing. This type of healing is less reliable because tendons and bones are dissimilar materials. Similar materials heal reliably to each other, as in bone-bone, muscle-muscle, or tendon-tendon. Dissimilar materials, tendon-bone healing, comparable to mixing oil and vinegar— is challenging.

Remarkably, however, between 60% to 85% of individuals with rotator cuff tears appear to achieve successful outcomes through non-surgical managements. In fact, within the entire population, over 95% of all individuals with complete full-thickness rotator cuff tears beyond the age of 65 ultimately opt out of surgery, because they all seem to be doing “just fine.”

In the end of day, receiving the diagnosis of a rotator cuff tear doesn’t signify the end of the world. Ultimate outcomes hinge on your personal goals and expectations. Your prospects for a positive result are decidedly favorable, provided you possess a clear sense of self-awareness, regardless of whether you opt for surgery or not.

Above all, the crucial shared factor, regardless of the surgical decision, revolves around effective management, rehabilitation, and strengthening of the rotator cuff. Remarkably, individuals with rotator cuff tears can still enhance their shoulder strength, with appropriate techniques and reasonable expectations.