What is the rotator cuff?
The rotator cuff is made up of 4 muscles which control how well your shoulder works. If a tear in the rotator cuff is large enough it can affect how well the shoulder will function. Most rotator cuff tears are actually due to degeneration of your tendons. Some tears may occur because you were injured… such as a fall, or sports injury. What should you know?
1. The most common cause of a rotator cuff tear is degeneration. That means your tissue simply wore out over time. These tears can become larger with time, but that is not always the case. Many degenerative tears are very small. Many patients with degenerative tears can avoid surgery. Inquire about your type of tear. If you have a small degenerative tear, a discussion about surgery should only occur after you have failed a proper non-surgical treatment regimen. Recent advances have enabled us to repair rotator cuff degeneration and degenerative rotator cuff tears with a biological patch.
2. Trauma or injuries can cause rotator cuff tears. If you have fallen on your side, and now you find that you cannot move your arm due to pain and weakness, you might have a large traumatic tear of the rotator cuff. Traumatic tears are treated differently than degenerative tears. In this case, you had a normal tendon which tore because of a traumatic event. These injuries are typically treated with surgery to repair the rotator cuff. So if you fell and now have significant weakness… do not wait too long before seeing an orthopedic surgeon. If your tear is large, it will retract and turn to fat. It is better to treat these sooner rather than later.
3. Muscles in our body are under tension like a rubber band stretched between two fingers. If a tendon is torn on one end, it will start to retract or pull back towards the other end. If you have a large tear, then your rotator cuff tear can retract significantly. If it has retracted more than 3 centimeters the repair might be difficult to perform, and your result might suffer or degrade with time. When a muscle is not functioning well, it will turn to fat (also known as atrophy). If you have had a tear for a while, then there is a chance that the muscle has turned to fat and is NOT capable of working like a muscle. Unfortunately, once a muscle has turned to fat, it cannot turn back into muscle. However, even for these cases, there are new advanced procedures to help retain shoulder function.
4. Just because something is torn, it does not mean it needs to be fixed. I see far too many second opinions where people had an MRI, were diagnosed with a small tear and told that they need surgery. The reason given for the need for surgery was simply because something was torn. That’s simply not true. Many people are living with tears of their rotator cuff and do not even know they have one. Just because something is torn does not mean it needs to be fixed. There are several non-surgical treatment options to help you get back to a healthy shoulder.
5. Be treated like a person… not an MRI finding. All people are not created equal. All tears are not created equal. When determining what the proper treatment option is for you, your surgeon must take into account the type of tear you have, your story, your goals, your current quality of life and whether or not those goals are achievable given your exam, and your MRI findings.