How do I know if i have a rotator cuff tear?

This post is a continuation of our talk on rotator cuff tears. Today, we will be discussing the symptoms and diagnosis of rotator cuff tears. Previous posts included:

• What is a rotator cuff tear?

• What causes rotator cuff tears?

The most common symptoms of rotator cuff tears are:

• pain at night, especially if lying on the affected shoulder

• pain when lifting or lowering your arm or with specific movements

• weakness when lifting or rotate your arm

• cracking or popping sensation when moving her shoulder in certain positions, especially overhead

Tears that happen suddenly, such as from a fall or when lifting something heavy usually cause intense pain.  You may also notice that you are unable to lift your arm after this injury.
Tears that develop slowly due to overuse, usually begin by some vague pain in her shoulder that progresses to worsening pain and then significant pain and weakness.

Some rotator cuff tears, especially those that occur slowly over time, are sometimes not painful.  These tears, however, may still result in some weakness and other symptoms.

Rotator cuff tears can be diagnosed with history and physical examination on most occasions.  Sometimes, advanced imaging such as MRI or ultrasound can be used to confirm a diagnosis of a rotator cuff tear.

Stay tuned for the next post on rotator cuff treatment.

What causes rotator cuff problems?

This is a continuation of my blog series on rotator cuff issues. Today, we will discuss what causes rotator cuff problems.

Rotator cuff problems can fall along a wide spectrum of issues.  The most common is inflammation of the rotator cuff called rotator cuff tendinitis.  Along with this issue is inflammation of the bursa sac called bursitis.  Sometimes, the rotator cuff tears off of the humerus bone.  This can range from a small, partial tear of the rotator cuff tendon to a complete tear of the rotator cuff tendon.  Many times, complete rotator cuff tears begin with minor tendinitis that progress to partial tearing and then complete tear.

There are two main causes of rotator cuff tears: acute injury and degeneration.

Injury to your rotator cuff is usually caused by lifting something very heavy with a jerking motion.  This can tear the rotator cuff tendon off of the humerus bone.

Location of rotator cuff pain

Degenerative tears are by far the most common type of rotator cuff tears.  These tears are often caused by wearing down of the tendon slowly over time.  This type of tear usually starts with tendinitis and progress to partial thickness tears and complete tears.  These can be due to repetitive stress or just wear over time.

Stay tuned for more information about rotator cuff tears. More information can be found here.

What is the rotator cuff?

The rotator cuff

A common condition that I see and am asked about in clinic is rotator cuff tears.

Rotator cuff problems are some of the more common and frustrating issues that patients can deal with throughout their lives.  Rotator cuff issues can weaken your shoulder and make activities of daily living, like combing your hair or getting dressed painful and difficult to do.

What is the rotator cuff?

Your shoulder is made up of three bones:

• your upper arm bone, called the humerus,

• your shoulder blade, called the scapula, and

• your collar bone, called the clavicle.  

Your arm is partially kept in your shoulder socket by the rotator cuff.  The rotator cuff is a group of four muscles that come together to form tendons that cover the head of your humerus.  The rotator cuff attaches to the humerus and allows you to lift and rotate your arm.  

On top of your rotator cuff, you have a lubricating sac called the bursa.  The bursa allows your rotator cuff to freely glide when you move your arm.  Sometimes, the rotator cuff or the bursa become inflamed and painful.

shoulder bursa

Stay tuned for more information about rotator cuff tears. More information can be found here.

Use of Platelet-Rich Plasma for the Improvement of Pain and Function in Rotator Cuff Tears: A Systematic Review and Meta-analysis With Bias Assessment. #ASES #AAOS #Health

https://www.ncbi.nlm.nih.gov/pubmed/31743037?dopt=Abstract

I am routinely asked about platelet rich plasma (PRP) treatment for rotator cuff tears. PRP is obtained from a patient’s blood and is then injected into injured tissue like rotator cuffs. Many physicians perform this procedure (I do not), but the effectiveness has not been well established at the time of this blog. The above article looked into the effectiveness for rotator cuff tears. Their conclusion that “significant improvements in PRP-treated patients were noted for multiple functional outcomes, but none reached their respective minimal clinically important differences” shows that the PRP has yet to show any functional improvements for rotator cuff tears. I encourage patients to have frank discussions with their physicians about the potential risks and benefits of this procedure before proceeding.

Early Rotator Cuff Shoulder Repairs Lead to Promising Results #Health #rotatorcuff #Seattle

Rotator cuff tears are a very common condition, causing pain and reduced movement of the shoulder. While these injuries may not demonstrate symptoms at first, gradual degeneration may cause shoulder pain and other symptoms to develop within a few years

 "Repairs of isolated supraspinatus tears maintained considerable improvement in clinical and radiographic outcomes at 10 years," according to the report by a French orthopedic surgery research group. The lead author was Philippe Collin, MD, of CHP Saint Gregoire Vivalto Sante. The study provides new evidence that early surgery for supraspinatus tears can improve long-term outcomes by preventing later rotator cuff muscle degeneration.

 The researchers, in a French multi-site clinical setting, identified 511 patients at 15 hospitals who underwent complete rotator cuff tear surgery.  These same patients were had a clinical longitudinal research follow-up ten years later, where 288 patients returned for follow-up evaluation, including MRI scans in 210 patients.

 The results of these patients saw substantial improvement of quality of life as well as general range of motion and use of the affected shoulder. The average Constant score -- a standard assessment accounting for shoulder motion, strength, daily activities, and pain -- improved from about 52 (out of a possible 100) before surgery to 78 at ten years' follow-up. The MRI scans showed similar results with a marked improvement in the quality of the tendon strength.

 Journal Reference

 Philippe Collin, Jean-François Kempf, Daniel Mole[Combining Acute Accent], Nicolas Meyer, Charles Agout, Mo Saffarini, Arnaud Godene [Combining Grave Accent] che. Ten-Year Multicenter Clinical and MRI Evaluation of Isolated Supraspinatus Repairs. The Journal of Bone and Joint Surgery, 2017; 99 (16): 1355 DOI: 10.2106/JBJS.16.01267

Do non-surgical factors affect recovery after a rotator cuff repair? #AAOS #Health #Seattle

A recent paper - A prospective evaluation of predictors of pain after arthroscopic rotator cuff repair: psychosocial factors have a stronger association than structural factors set out to answer this question. 

Many shoulder surgeons like myself have noticed that patients can have a wide range of outcomes after the same rotator cuff repair surgery.  This paper gives further evidence that many psychosocial factors can affect the result of surgery and need to be addressed to maximize a patient's outcome.  Patients with preoperative narcotic use, higher preoperative pain scores, and lower scores on the WORC (rotator cuff questionnaire) index and emotion sections.

I am immensely interested in studying how we can use different technologies and treatments to best address the psychosocial factors that we all have our shoulder and elbow patients.  Check out more about my research in this field here.

If you have a rotator cuff tear and are considering rotator cuff surgery, please ask your shoulder surgeon if there is anything that you can do before surgery to improve your outcome.

Could artificial muscles be an answer for chronic rotator cuff tears?

 Could artificial muscles be an answer for chronic rotator cuff tears?  This is a question that I couldn't help but ask myself while reading this fascinating article.  The rotator cuff is a collection of 4 muscles and tendons that allow us to raise our arms.  As many know, chronic (old) rotator tears are a very difficult problem to treat and can lead to severe disability in patients.

Shoulder specialists have been trying for years to determine the optimum treatment for chronic rotator cuff tears.  Our current treatment for old rotator cuff tears is evolving and may include a simple "clean out" of the joint, placing a graft where the rotator cuff tendon was (a superior capsule reconstruction) or a reverse shoulder replacement.  No one solution achieves return to full function due to the fact that rotator muscles atrophy and are no longer functional.

Artificial muscles may allow us the ability to transplant and replace the atrophied rotator cuff muscles and regain significant function.  Although this research is very exciting, I would be remiss to say that this artificial muscle research is still in it's infancy and has not, to my knowledge, been proposed for use in shoulder surgery, so stay tuned.  

I will continue to research this and other treatments and devices here and on my upcoming website the orthopedicfuturist.com.