Shoulder Pain? Rotator Cuff Surgery May Be in Your Future

Dr. Ryan Kehoe, Aspen Orthopedic Specialists

If you’re experiencing shoulder pain, you already know how it can disrupt your day-to-day activities. But what’s the cause of your discomfort, and how can you address your shoulder pain (and make it stop)? Should you consider rotator cuff surgery?

The rotator cuff is an essential functional part of the shoulder and also a frequent source of shoulder pain. Rotator cuff damage is especially noticeable when performing overhead activities.

While rotator cuff injuries happen to people of all ages, they’re more common in adults over age 40. Rotator cuff tears may occur due to aging or jobs where you perform repetitive overhead activities (like painting and construction). Rotator cuff injuries due to overuse are also common in athletes, such as baseball pitchers, tennis players, and weightlifters. 

Untreated rotator cuff injuries may lead to muscular imbalance and subtle coordination issues of the shoulder that exacerbate the problem and pain. Proper functioning of the rotator cuff is crucial for shoulder movement, which is why treating and monitoring your shoulder pain is essential. While rotator cuff surgery isn’t always necessary, it may be an option to consider.

Dr. Ryan Kehoe from the Orthopaedic Hospital of Wisconsin’s surgical team explains the different types of rotator cuff injuries. He provides expertise on how to treat these injuries properly, whether through physical therapy or rotator cuff surgery, and return patients to a pain-free life.

What is Causing Your Shoulder Discomfort?

When exploring the cause of shoulder discomfort, it’s helpful to understand a bit about shoulder anatomy.

The rotator cuff is in your shoulder and consists of four tendons that control the movements of the humeral head or the “ball” portion of the ball and socket joint. These four tendons are known as the subscapularis, teres minor, supraspinatus, and infraspinatus. They work in unison to create stability in the shoulder joint and allow precise movement of the humeral head.

Often, shoulder discomfort is due to an inflamed or torn tendon known as rotator cuff tendonitis. The dysfunction of the rotator cuff may lead to an imbalance in the shoulder, causing the humeral head to elevate up into the acromion or the plate of bone above the ball and socket joint. If this occurs, the sequence further pinches the rotator cuff and the surrounding bursa creating a painful problem called shoulder impingement

Other structures in the shoulder are frequently problematic, and these issues may accompany rotator cuff injuries and tears. These shoulder structures include the labrum, the long head of the biceps tendon, and the acromioclavicular joint where the collar bone comes together with the acromion at the top of the shoulder.

Fortunately, if you’re experiencing pain in your shoulder, an orthopedic expert can assess and pinpoint the source of the discomfort. Whether the injury is to your rotator cuff only, or there’s damage to the surrounding structures, a surgeon will address them during rotator cuff surgery using arthroscopic techniques.

Taking A Non-Operative Approach Before Proceeding with Rotator Cuff Surgery

Of course, surgery isn’t always the best answer for shoulder pain. Before we consider rotator cuff surgery, we typically explore several non-operative treatments to address shoulder injuries. Treatment usually includes a combination of physical therapy and anti-inflammatory medications, but it’s not a one-size-fits-all approach. Consult your physician to devise a treatment plan best suited to your specific shoulder injury before pursuing a course of action.

Another treatment option includes corticosteroid injections that a physician administers to the injured shoulder. This treatment option decreases the inflammation and pain in the rotator cuff, improving the function of the joint. Similarly, physical therapy can help to strengthen the inflamed rotator cuff and improve function—in the process, bringing the humeral head back down into the ball and socket joint. This approach decreases the pinching or impingement in the shoulder and will relieve inflammation and pain.

Evaluating the Status of the Shoulder Before Surgery

If your physician determines that rotator cuff surgery is the right answer for your shoulder pain, the process is minimally invasive and typically highly successful.

Before proceeding with any surgical intervention in the shoulder, your physician will take an MRI to evaluate your rotator cuff. There are two different types of rotator cuff tears—a partial-thickness tear and a full-thickness tear. Depending on the type of tear, your doctor will recommend different treatment options.

Dr. Kehoe states, “More often than not, we will see some thinning of the rotator cuff called a partial-thickness tear. This is a common degenerative change that we find in shoulders.” A partial-thickness tear isn’t see-through, but merely a thinning of the attached tendon. When we see this type of tear, it usually doesn’t change our treatment approach significantly.

However, when there is a full-thickness tear—or a tear one can see through—it’s a more significant problem. A full-thickness tear means the rotator cuff has completely torn, and the tendon has pulled away from the humeral head or “ball” of the ball and socket joint. Like a rip in a pair of jeans, the tear only grows over time. Physicians almost always recommend rotator cuff surgery to repair full rotator cuff tears.  

Arthroscopic Rotator Cuff Surgery

When impingement of the rotator cuff and overlying bursa doesn’t respond to conservative treatment, doctors will typically recommend you proceed with rotator cuff surgery. Before going in for shoulder surgery, prepare for your procedure. Knowing what to expect will alleviate pre-surgery jitters and make the process less stressful.

Surgeons can perform rotator cuff surgery through open repair or arthroscopic repair. The traditional open repair method—when the surgeon makes one large incision in the shoulder—is now used infrequently. Today, it’s common for doctors to repair either type of rotator cuff tear (full or partial-thickness) in a minimally invasive fashion. 

Surgeons perform arthroscopic rotator cuff surgery through several small incisions in the shoulder.  Dr. Kehoe states, “This type of surgery is done under a general anesthetic with small poke hole type incisions and a camera. We’re able to remove the inflamed bursal tissue over the rotator cuff and smooth the undersurface of the bony plate, or acromion, to allow more space for the tendon to glide underneath.” 

The surgery itself is a minor outpatient procedure, but postoperative recommendations are usually a bit more extensive. The rotator cuff surgery itself takes about 45-minutes, and in most cases, you leave the hospital the same day as your procedure.

Regaining Strength and Motion After Rotator Cuff Surgery

After rotator cuff surgery, patients typically require 6 to 8 weeks for the tendon to heal back to the bone. Physicians usually recommend a sling worn for around six weeks to limit the motion of your shoulder and allow the tendon to heal. Additionally, physicians will generally prescribe 2 to 3 months of post-op physical therapy to help limit stiffness in the joint, work on strength, and increase range of motion.

Smaller tears recover quickly, whereas larger, more extensive tears require a slow and steady approach after surgery. As with most procedures, it’s essential to see the entire recovery process through to ensure appropriate healing and a return to the proper long-term function of the shoulder. After having larger tears repaired, patients also require more time to regain their lost strength and rebuild the bulk of the rotator cuff muscles.

After an accurate diagnosis and efficient treatment to treat rotator cuff problems, patients can expect an excellent outcome and resolution of their symptoms. If you’ve been suffering from shoulder pain, seek medical help before the problem worsens. Reach out to the professionals at the Orthopaedic Hospital of Wisconsin to receive the care you need today.