When Is It Time for Rotator Cuff Surgery?

Christie Auyeung Orthopedic Surgery Leave a Comment

Do you have persistent shoulder pain? If your pain is concentrated in the front or outside of the shoulder, and gets worse when you raise your arm or lift something above your head, you may have a rotator cuff injury. This type of shoulder pain can get in the way of doing simple tasks, and can be bad enough to wake you up at night.

If you have a rotator cuff tear, you have a few options. First, let’s break down key points about the rotator cuff, and how to know it may be time for surgery.

What is the rotator cuff?

The rotator cuff is a group of four tendons and muscles in the shoulder. Together, they keep your shoulder stable and help you raise and twist your arm.

What causes rotator cuff pain?

A rotator cuff tear can result from an injury, such as a fall during a sports or car accident.  Rotator cuff damage can also be a result of normal wear and tear in individuals over age 40. Age-related rotator cuff damage occurs when the tendons rub repeatedly against the bone, causing inflammation and tearing.

How do I know if I have rotator cuff damage?

A telltale sign of rotator cuff tear is pain in the front of your shoulder that radiates down the side of your arm. You may feel the pain worsen when you lift or reach above your head, or when you try to sleep on the affected side. When doing things like combing your hair or reaching behind your back, you may feel weakness in your arm. If you tore your rotator cuff due to an injury, you likely experienced a snapping sensation and immediate pain and weakness of the arm.

When is it time to see a doctor?

Without any treatment, your shoulder pain may get worse over time. If you are feeling pain after an injury, it’s best to see your doctor as soon as you can. In the meantime, try using an ice pack, resting your arm, and taking pain medication if necessary.

Are there non-surgical treatments?

If your doctor diagnoses you with a rotator cuff tear, you may not necessarily need surgery right away. In fact, your doctor will likely have you first try non-surgical treatments to relieve pain and restore strength, and suggest surgery only if these alternative treatments don’t help.

A few non-surgical treatments that can help reverse the early stages of rotator cuff damage include:

  • Rest: Try not to use your shoulder for reaching above you or lifting objects. Rest the shoulder, but move it gently from time to time to avoid stiffness.
  • Ice: Using ice packs wrapped in a thin towel, followed by moist heat, can help reduce pain and inflammation.
  • Anti-inflammatory medicines: Follow instructions from your doctor about taking medications to reduce pain and inflammation.

Can physical therapy treat a rotator cuff tear?

Physical therapy can help strengthen the shoulder muscles around the torn tendon. It can also help improve your range of motion and allow your shoulder to move more freely and smoothly. Physical therapists can also train you to lift objects and do other activities using muscles that don’t hurt and put less stress on the torn rotator cuff muscles. After you learn how to do the exercises, you can continue to do them at home. A physical therapy program usually lasts several weeks. If your shoulder improves with physical therapy, you may not need to have surgery.

When is it time for surgery?

If you are active and need to lift your arms above your head for work or sports, you may need to have surgery to restore the tear. Pitchers, swimmers and tennis players are more likely to need surgery in order to return to their sports.

Your doctor may also recommend surgery if your shoulder pain and weakness does not go away after 3 to 6 months of non-surgical treatment. If you have pain when lifting or reaching your arm that wakes you up at night despite months of medication and physical therapy, you may be a good candidate for rotator cuff surgery.

 What does rotator cuff surgery entail?

Surgery to repair a torn rotator cuff entails removing scar tissue, fluid sacs, and loose pieces of tendon and debris from the space in the shoulder where the rotator cuff moves. This is called a “debridement.” Additionally, your surgeon may shave down or remove irregularly shaped bone in order to make more room for the rotator cuff to move. Then, your surgeon will sew the torn edges of the rotator cuff tendons together and reattach them to the arm bone.

It’s important to remember that even if you choose to have rotator cuff surgery, you will still need to complete an exercise or physical therapy program afterwards. This is because when a tear occurs, and when you recover from surgery, your surrounding muscles become weak from lack of use. In order to regain full use of your shoulder and arm after surgery, you will have to complete a rehabilitation program, which may take several months.

If you are experiencing shoulder pain or are considering rotator cuff surgery, don’t hesitate to reach out to one of our doctors today!

Christie is a UChicago grad currently living in the San Francisco Bay Area. In her free time, she enjoys tap dancing, learning to windsurf, and trying new foods.