Eric J. Kropf, MD
Rotator Cuff Tears and Tendinitis
Patient Information and FAQs
What is the Rotator Cuff?
The rotator cuff is a group of 4 small muscles
around the shoulder (1. supraspinatus; 2.
infraspinatus; 3. teres minor; 4.
subscapularis). These four muscles attach to
the humerus or upper arm by tendons that
grow into the bone. The four muscle
function together like 4 reigns pulling on a
horse to lift and rotate the arm.
When inflammation and impingement persist,
the cuff may begin to tear, similar to a frayed
piece of rope. Partial tears or fraying can
progress to full-thickness tears when the tendon
becomes completely detached from bone.
The rotator cuff muscles are especially
important in stabilizing the shoulder with
overhead activities and providing power for
certain sporting activities (throwing a
baseball or football; swimming; playing
tennis).
How is the rotator cuff injured?
Most rotator cuff injuries result from overuse
that causes swelling or inflammation in the
rotator cuff muscle/ tendons. Once inflamed
and swollen, the tendons can be pinched by
the surrounding bones of the shoulder (bone
spur or subacromial spur). This leads to
more inflammation/ swelling and the cycle
continues. This is commonly referred to as
rotator cuff tendonitis, bursitis or
“impingement syndrome”.
In rare cases a severe injury (fall from height;
sports injury) can tear the rotator cuff directly
off of the bone.
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How do I know if my rotator cuff
is injured?
How are Rotator Cuff injuries
treated?
People with rotator cuff injuries typically
experience pain that is worse at night or with
overhead activities. Difficulty sleeping
because of the pain is common. With larger
rotator cuff tears, patients will experience
weakness or difficulty doing their normal
activities or exercise routine.
Rest and over-the-counter medications may
relieve symptoms temporarily, but if pain
and/or weakness persist rotator cuff injury is
likely.
Most rotator cuff injuries (tendonitis/ bursitis/
impingement) will respond to non-operative
treatment. This consists of anti-inflammatory
medication, physical therapy and in some
cases, an injection of steroid medication. The
goal of physical therapy is to reduce swelling
and inflammation while improving motion and
strength.
Do I need Xrays or MRI?
Shoulder xrays are routinely performed. This
allows your doctor to rule out other serious
causes of shoulder pain. This also provides
the best picture of the surrounding bones and
potential bone spurs.
Your doctor will likely suggest an MRI if a
rotator cuff tear is suspected. This could be
after a serious injury or if significant
weakness is noted on physical exam. If
rotator cuff tendinitis/ bursitis is treated for
>6 weeks without significant improvement,
you should have an MRI performed. An
MRI will best show if a rotator cuff tear is
present.
Rotator Cuff Tendon
Cuff Tear
Will I need surgery?
If a large rotator cuff tear is present, surgery is
typically recommended. Symptoms may wax
and wane, but the actual rotator cuff tear rarely
heals by itself. Instead, tears tend to progress
leading to worsening pain and weakness. Once
the tendon is detached from bone, the muscle
shortens like a spring, pulling the tendon
further and further away from the bone.
Some patients without definite tear will have
continued pain from tendonitis and
impingement of an overlying bone spur. In
these cases, if conservative treatment does not
meet the patient’s goals, surgery may be an
option.
Will this be “Arthroscopic
Surgery”?
In almost all cases (95% of the time), rotator
cuff surgery can be performed arthroscopically.
This can be done with 3-4 small “poke-hole”
incisions. A small fiber-optic camera is
inserted into the shoulder and images are
viewed on a high-definition TV monitor. This
allows for evaluation of the entire shoulder
including rotator cuff, bone spurs, cartilage,
ligaments and the biceps tendon. Small
(<5mm) instruments are inserted at the same
time to repair or remove damaged tissues or
bone spurs.
Because only small incisions are made,
physical therapy and recovery can be expedited
after arthroscopic shoulder surgery.
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How is the rotator cuff repaired?
In most cases, the rotator cuff is repair through
the arthroscope. Small suture anchors (figure)
or screws with suture are placed in the bone.
The suture is passed through the torn tendon
and tied, pulling the tendon back to its correct
attachment site. These anchors are
bioabsorbable, meaning that they dissolve and
turn to bone. No metal implants are used and
nothing will need to be removed with later
surgeries.
After Surgical Repair:
Repaired Rotator Cuff
Rotator Cuff
Will I need any other surgery?
Humerus
In roughly 5% of cases, the rotator cuff may be
large and long-standing making an allarthroscopic repair impossible. In these cases,
a small (2-3 inch) incision will need to be made
to repair the torn rotator cuff.
In some cases of long-standing rotator cuff
injury, the biceps tendon becomes inflamed or
partially torn. This will be looked at closely
during surgery. If the tendon is torn and/ or a
significant cause of pain, a biceps tenodesis
will likely be performed. A biceps tenodesis
consists of removing the torn portion of the
tendon and reattaching the tendon to a new,
less painful site. This does not result in any
noticeable weakness or dysfunction of the
biceps after surgery.
Some patients may have pain related to
acromioclavicular (AC) joint arthritis. In these
cases, the arthritic end of the bone will be
removed to reduce pain and symptoms. This
does not result in any residual weakness or
deformity.
What happens the day of
surgery?
Our staff will assist you through all stages of
the process. You will likely require some
minor bloodwork, an EKG (heart function test)
and Chest Xray prior to any surgery.
You will be called the night before surgery and
directed where and when to report. You will
report to the preoperative holding area and be
“checked in”. Next, you will meet the
anesthesia team and discuss your options for
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anesthesia. Your treating surgeon will review
final details and answer any final questions
prior to surgery.
After surgery, you will return to the recovery
room, where you will be monitored by our
nursing staff for several hours. Your family
will be able to come back and see you at this
point. When you are feeling comfortable,
without significant nausea or pain, you will be
discharged to home. Nearly all patients are
able to go home the day of surgery, but if there
are any issues, you can easily be admitted
overnight for monitoring.
When can I change dressings/
shower?
The dressings placed on you immediately after
surgery may be removed 48-72 hours after
surgery. The steri-strips (cloth/paper strips
placed over your incisions) may be left on until
your first post-operative visit, however if they
come off a band-aid or similar cover may be
used.
You may shower 3-5 days after your surgery.
Do not scrub or soak your shoulder. You may
use mild soap and water over the incisions and
pat the shoulder dry before reapplying the
sling.
How long will I need to wear a
sling?
If rotator cuff repair is performed, you will
need to be in a sling for 4-6 weeks. You can
remove it several times a day for grooming and
to perform a few simple exercises.
When can I return to work?
You can return to school or work 5 to 7 days
after the surgery, without using the affected
arm. If your work requires the use of the
involved arm, you will need to be off for a
greater period of time. You will need to
discuss this with your treating physician.
Will I need to attend physical
therapy?
Physical therapy is a key part of recovery after
shoulder surgery. You should begin home
exercises as instructed the day after surgery.
Formal therapy will begin shortly after. The
attached physical therapy protocol should be
given to your therapist. If questions arise, your
therapist should contact your physician to
discuss your progress.
When can I return to sports/ full
activity?
Every patient’s recovery is different, but in
general, most people can return to full
unlimited activity at roughly 6 months post-op.
This is dependent on your progress in regaining
full motion and strength.
What if I have questions?
Do not hesitate to contact any of our affiliated
offices. Our staff is available to assist you
through this process.
** Images courtesy of AAOS patient information
handouts: orthoinfo.aaos.org
For more information please visit: ortho.templehealth.org