What If The Patient Lives A Long Way Away From Seattle
Because this procedure is not performed in many centers across the United States patients often come to Seattle from a long distance for the procedure. We are available by appointment in the Shoulder and Elbow Clinic 4245 Roosevelt Way N.E. Seattle on Mondays and Fridays to evaluate individuals with shoulder arthritis to discuss the procedures that might be most ideally suited for them. We perform surgery on Tuesdays and Wednesdays at the University of Washington Medical Center 1959 NE Pacific St Seattle Washington. Patients having rotator cuff surgery are usually able to return home three days after the procedure assuming they have mastered their exercises. The sutures used to close the skin can be removed by a nurse or physician near the patients home. Ideally we like to see patients back at six weeks after surgery to assure that satisfactory progress is being made. We request that patients complete questionnaires at 3, 6, 12, 18 and 24 months after surgery so we can track their progress and that the patient obtain and send to us X-rays at 12 and 24 months after surgery if they are unable to return to Seattle for the annual follow-ups. All patients have our personal email and the clinic contact phone numbers to use in contacting us at any time questions arise.
What Is The Prognosis For People Who Have A Rotator Cuff Tear
Most people see improvements with nonsurgical treatments. Recovery takes time because your body needs time to heal. Most people who have surgery to repair a torn rotator cuff regain function.
Its possible to tear the same tendon again, especially if the first tear was bigger than 1 inch. A re-tear that causes severe pain or loss of movement may require surgery.
How Is A Rotator Cuff Injury Treated
Treatments range from resting the affected arm to surgery. Tendinitis can progress to a rotator cuff tear, and that injury can get worse with time. Seeking treatment as quickly as possible helps to keep the injury from progressing.
Nonsurgical treatments improve symptoms in about 80 percent of people with a rotator cuff injury. These kinds of treatments include:
- applying hot or cold packs to the affected shoulder to reduce swelling
- exercises to restore strength and range of motion
- physical therapy
- injecting the affected area with cortisone, a steroid that helps to reduce inflammation
- resting the affected arm and wearing a sling to isolate arm motions
- over-the-counter anti-inflammatory medications, like ibuprofen and naproxen
According to the American Academy of Orthopaedic Surgeons, theres no evidence that the timing of surgery affects outcomes. This means if you have a rotator cuff injury, your doctor is likely to first try nonsurgical methods.
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Symptoms Of Rotator Cuff Tendinopathy
If you have rotator cuff tendinopathy, you will notice pain in the outer part of your upper arm and sometimes the front and top of your shoulder. This could be worse when you raise your hands above your head or reach behind you. It could also wake you up at night.
You also might notice:
- Swelling and tenderness in the front of your shoulder
- A âclickingâ in your shoulder when you raise your arms over your head
- Loss of strength or range of motion
- Joint stiffness
What Are Nonsurgical Treatments For Rotator Cuff Tears
Rotator cuff tears do not heal on their own without surgery, but many patients can improve functionally and decrease pain with nonsurgical treatment by strengthening their shoulder muscles. Just because there is a tear, does not necessarily mean a surgery is needed. About eight out of 10 people with partial tears get better with nonsurgical treatments. It can take up to a year for the condition to improve.
Nonsurgical treatments include:
- An arm sling and rest to give your shoulder time to heal. You may need to modify activities and stop certain work or sports for a period of time.
- Nonsteroidal anti-inflammatory drugs to minimize pain and swelling.
- Physical therapy to learn strengthening and stretching exercises.
- Steroid injections to ease pain and swelling.
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When Is It Likely That A Cuff Tear Can Be Repaired
In patients who are healthy and non-smokers a durable rotator cuff repair can often be achieved as long as there is a sufficient amount of good quality tendon for the repair. With time after a tear the tissue weakens and retracts leaving the humeral head exposed and making a durable cuff repair less likely.
How Is A Rotator Cuff Injury Diagnosed
In addition to a complete medical history and physical exam, diagnostic procedures for a rotator cuff injury may include the following:
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X-ray. A diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
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Magnetic resonance imaging . A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
A rotator cuff may tear partially or fully. Partial-thickness tears do not completely sever the tendon from the shoulder.
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Why Is The Pain Worse At Night
Thats a little bit of a mystery. Healthcare professionals have some ideas why it hurts more at night primarily related to blood flow and muscle tension but theres really no definitive reason, says Kinsey.
Your body is quieter at night, says Kinsey, so youre more likely to hear the thing in your body screaming the loudest.
Key Points About Rotator Cuff Injury
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Your rotator cuff allows you to lift your arms and reach upward.
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There are 2 main causes of rotator cuff tears: injury and degeneration.
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The symptoms of a rotator cuff tear may resemble other conditions or medical problems. It is important to talk with your healthcare provider for a diagnosis.
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Your healthcare provider will determine specific treatment for your rotator cuff injury.
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Treatment Of Rotator Cuff Injuries
The type of treatment youll have depends on several factors. These include the type of injury you have, how severe it is, your age and how active you usually are.
Sometimes, your doctor may recommend surgery to repair a rotator cuff tear. A rotator cuff tear wont usually heal on its own, without surgery. But non-surgical treatments can help to relieve pain and build up strength in your shoulder. Not all rotator cuff tears require surgery. For many people, non-surgical management can be enough to allow you to use your shoulder again.
Your doctor will discuss your options with you and help you to decide whats best for you.
What Are The Complications Of A Rotator Cuff Injury
The most common complication is re-tearing the rotator cuff after its healed. The larger the original tear, the higher the risk of a re-tear.
If the injury requires surgical repair, the risk of postoperative complications is small. General surgical risks include blood loss or issues with anesthesia. Complications related to the procedure itself include:
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Physical Therapy And Exercises
Your doctor will likely refer you to a physical therapist to learn exercises for your shoulder.
- You may start with passive exercises. These are exercises the therapist will do with your arm. Or, you can use your good arm to move the injured arm. The exercises may help get the full movement back in your shoulder.
- After that, you will do exercises the therapist teaches you to strengthen your shoulder muscles.
What Is Rotator Cuff Tendinopathy
Rotator cuff tendinopathy is when a tendon in your shoulder has tiny tears in it or is inflamed and hurts. Itâs usually caused by overuse or general wear and tear. Sometimes called tendinosis or tendinitis, this type of shoulder pain is more common in people over age 30. If itâs not treated, it can lead to stiffness or weakness in your shoulder and other long-term problems.
Each of your shoulders is made up by a group of muscles and tendons called a rotator cuff. This keeps your upper arm inside your shoulder socket. It also gives you the strength and motion to rotate and lift your arms.
The wear and tear on shoulders from repeated overhead activities can lead to recurrent injury and rotator cuff problems. This includes common activities like weightlifting, swimming, tennis, golf, and many physical jobs. While historically this was called tendinitis, that term is now used for more sharp, inflammatory shoulder pain.
People older than age 40 are most likely to have rotator cuff problems, in general. Genes may also play a part. If someone else in your family has shoulder issues, then you may be prone to get them, too.
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What Is A Rotator Cuff Injury
Your rotator cuff consists of muscles and tendons that hold your shoulder in place. It is one of the most important parts of your shoulder.
Your rotator cuff allows you to lift your arms and reach upward. Each year, millions of people in the United States go to their healthcare providers because of a rotator cuff problem. A rotator cuff tear is a common cause of pain and disability among adults.
Can A Torn Rotator Cuff Heal Itself
Sadly, a rotator cuff tear cannot heal on its own. This is true for any tear, from minor to a complete one.
See, rotator cuff tears happen on the enthesis of our upper arm bone. This is the transition zone between your tendon and bone. Unfortunately, this area has a poor blood supply, making it harder for repairing cells to reach the tendon.
Thats why getting medical treatment is key to getting your shoulder better. And no, surgery is not always the go-to solution for rotator cuff tears. Up to 80% of patients do well by trying different conservative treatments.
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Who Should Consider A Rotator Cuff Surgery
Surgery should be strongly considered in the situation when sudden weakness follows a shoulder injury and when an examination and ultrasound or MRI shows a rotator cuff tear with reasonable remaining tissue for a repair. In shoulders with the gradual onset of shoulder weakness and without a significant injury surgery can be considered if a stretching and strengthening exercise program does not yield the desired improvement. Preoperative ultrasound or MRI along with a careful examination can suggest whether a repair is likely to be possible or if a smooth and move is likely to be the procedure of choice.
At What Point Does A Rotator Cuff Tear Require Surgery To Fix It
Surgery is recommended:
- If you have persistent pain or weakness in your shoulder that does not improve with nonsurgical treatment. Frequently, patients who require surgery will report pain at night and difficulty using the arm for lifting and reaching. Many will report ongoing symptoms despite several months of medication and limited use of the arm.
- In active individuals who use the arm for overhead work or sports. Pitchers, swimmers, and tennis players are common examples.
Additionally, surgery may be recommended for complete tears that are acute and due to a trauma.
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Summary Of Rotator Cuff Surgery For Rotator Cuff Tears Of The Shoulder
- Urgent rotator cuff repair should be considered when acute weakness occurs after a shoulder injury, provided that shoulder ultrasound or MRI document a repairable cuff tear.
- Rotator cuff surgery should be considered in chronic rotator cuff tears that have not responded to a trial of exercise has failed to yield the desired result.
- In the hands of an experienced surgeon rotator cuff surgery can be an effective method for treating shoulders with rotator cuff tears.
- Pre-planning and persistent rehabilitation efforts will help assure the best possible result for the patient.
Frederick A. Matsen III and Winston J. Warme Shoulder Surgeons
Is Pt For Me
If you think you have a tear, see your doctor. They may send you to someone who treats bones, joints, muscles, and tendons, called an orthopedic doctor. They can talk to you about surgical and nonsurgical options, including PT.
Unless the injury is severe, PT is a typical starting point. Your physical therapist will ask questions about your life and the things you do. Theyâll do some tests to learn more about your pain. The therapist will ask you to raise your arm, move it to the side, or push against something to see what your limits are.
PT helps in lots of ways. One study shows that people who got PT for a rotator cuff tear did just as well as those who had surgery.
The therapist will help you:
- Get back your range of motion
- Learn exercises to strengthen your shoulder muscles
- Improve the way you sit and stand to help reduce pain
- Find a way to sleep that doesnât hurt your shoulder
- Learn to carry objects safely
- Use ice or heat to ease the pain
- Understand why you need to keep moving
- Find ways to do things so that they donât hurt your shoulder
- Return to your regular activities
PT can also help you recover after rotator cuff surgery. Itâs the same idea — to improve strength and movement and get back to regular life. The therapist will show you how not to injure your shoulder again after surgery.
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The Best Way To Treat Rotator Cuff Tendonitis The Most Common Cause Of Shoulder Pain Is With Simple Home Therapies
Swinging a tennis racket, digging in the garden, placing a book on a high shelf, and reaching back to insert your arm into a sleeve these are some of the movements made possible by the shoulder’s enormous range of motion. We use this mobility in so many activities that when the shoulder hurts, it can be disabling. For younger people, sports injuries are the main source of trouble, but the rest of us have more to fear from the normal wear and tear that, over time, weakens shoulder tissues and leaves them vulnerable to injury. The risk is greatest for people with occupations or hobbies that require repetitive or overhead movements, such as carpenters, painting, tennis, or baseball.
The most common cause of shoulder pain is rotator cuff tendonitis inflammation of key tendons in the shoulder. The earliest symptom is a dull ache around the outside tip of the shoulder that gets worse when you push, pull, reach overhead, or lift your arm up to the side. Lying on the affected shoulder also hurts, and the pain may wake you at night, especially if you roll onto that shoulder. Even getting dressed can be a trial. Eventually, the pain may become more severe and extend over the entire shoulder.
When severe, tendonitis can lead to the fraying or tearing of tendon tissue. Fortunately, rotator cuff tendonitis and even tears can usually be treated without surgery.
How Can You Treat A Rotator Cuff Injury
For mild injuries, you may only need rest and ice. However, for severe injuries, you may require surgical intervention. At first, when conservative treatments do not reduce your pain, you may require steroid injections. Unfortunately, steroid injections should only be used temporarily because they could lower surgery success or weaken the tendon.
There are four main surgeries for rotator cuff injuries, including arthroscopic tendon repair, tendon transfer, open tendon repair and shoulder replacement. Shoulder replacements are only necessary for massive rotator cuff injuries. On the other hand, Tendon transfer may be necessary if the tendon cannot reattach to the arm. In general, the purpose of rotator cuff surgery is to reattach the torn tendon.
If you do not receive treatment, you could suffer from progressive degeneration of your shoulder joint.
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Once A Shoulder With Rotator Cuff Surgery Has Successfully Completed The Rehabilitation Program What Activities Are Permissible
Once the shoulder has a nearly full range of motion strength and comfort the patient may progressively resume activities. It is important to recall however that even with a solid and complete repair and with good healing the tendon will remain susceptible to re-injury for up to a year after surgery.
What Problems Can Complicate A Cuff Surgery And How Can They Be Avoided
Like all surgeries rotator cuff surgery can be complicated by infection nerve or blood vessel injury fracture instability and anesthetic complications. Furthermore this is a technically exacting procedure and requires an experienced surgeon to optimize the bony prosthetic and soft tissue anatomy at the procedure. The most common causes of failure are failure of a rotator cuff repair to heal or scar tissue that limits the range of motion after the procedure.
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When Is Surgery Necessary For A Rotator Cuff Tear
Unfortunately, non-surgical treatments are not 100% effective for all rotator cuff tears. And honestly, surgical treatments arent 100% effective, either.
But, its true that some people may have a better chance of recovery with surgery. In the following instances, a surgical approach may provide better results than non-surgical treatments :
- If you cant find symptom relief after 3-6 months of nonsurgical treatments.
- Young athletes with high shoulder stress.
- Overhead workers or laborers.
Rotator Cuff Tear Treatment
Every year in the U.S., nearly 2 million people visit their doctor to get relief from symptoms caused by issues with the rotator cuff, a part of the shoulder. Pain from a torn rotator cuff can make it hard to do even the simplest daily activities. And the longer you wait to get help, the worse the injury may affect you.
In our Shoulder and Elbow Program, our skilled, experienced orthopaedic team improves your symptoms and restores your quality of life. Using leading-edge technology and personalized therapies, they help you get back to the life you love, fast.
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