Rotator Cuff Tear

Rotator cuff tears are among the most frequent shoulder conditions causing pain and functional impairment. It is estimated that rotator cuff tears are responsible for 4.5 million annual patient visits in the US and nearly 250,000 operative repairs. Rotator cuff tears frequently occur in athletes but also occur due to trauma and “wear and tear” of the tendon over time. Rotator cuff tears can lead to significant shoulder weakness and pain, and treatment is frequently necessary.

Anatomy of the Shoulder

The shoulder is a “ball and socket” joint, with the ball-shaped head of the upper arm bone (humerus) fitting into a shallow socket called the glenoid. The rotator cuff is a group of four muscles that comes together as tendons to form a covering around the humeral head. The rotator cuff tendons attach to the humerus and help to lift and rotate the arm. The rotator cuff tendons also help stabilize the shoulder.

There is a lubricating sac called a bursa between the rotator cuff and the bone on top of your shoulder (acromion). This bursa (the subacromial bursa) allows the rotator cuff tendons to glide freely when you move your arm. When the rotator cuff tendons are injured or damaged, this bursa can also become inflamed and painful (subacromial bursitis).

Classification of Rotator Cuff Tears

Rotator cuff tears can be classified as follows:

  • Partial Tear. One or more tendons in the rotator cuff are damaged or frayed but are not completely detached from the bone.
  • Complete Tear. This is also called a full-thickness tear. With this type of tear, there is a hole in the tendon. Frequently, with a complete tear, one or more tendons in the rotator cuff are completely detached from the humerus.
  • Acute Tear. The tear is caused suddenly by injury/trauma, such as falling or lifting something too heavy. An acute tear can be a partial or complete tear.
  • Degenerative Tear. Degenerative tears occur gradually and naturally as we age. These can also be partial or complete tears of the rotator cuff tendon(s).

Over time, the rotator cuff is susceptible to degenerative changes. As we age, the blood supply to the rotator cuff can decrease, making it more difficult for the body to repair tendon damage naturally. This “wear and tear” on the rotator cuff can increase the likelihood of a rotator cuff tear or another injury.

Causes of Rotator Cuff Tears

A rotator cuff tear can occur suddenly. It may happen by falling onto an outstretched arm or lifting something heavy.

Rotator cuff tears can also develop slowly over time due to cumulative stress. Repetitive shoulder motions during sports and physical activity are often contributing factors. Rotator cuff tears are common among athletes in sports like baseball, tennis, and weightlifting/CrossFit.

Additionally, degenerative changes to the shoulder may increase the likelihood of rotator cuff tears. The rotator cuff may rub against the undersurface of the acromion, causing fraying and thinning. This condition is called shoulder impingement, and over time may weaken the tendon and make it more likely to tear.

Risk Factors

Because many rotator cuff tears are largely caused by the normal wear and tear that goes along with aging, people over 40 are at greater risk.

People who do repetitive lifting or overhead activities are also at risk for rotator cuff tears. Athletes are especially vulnerable to overuse tears, particularly tennis players and other overhead athletes. Painters, carpenters, and others who do overhead work also have a greater chance of tearing their rotator cuff.

Although overuse tears caused by sports activity or overhead work also occur in younger people, most tears in young adults are caused by a traumatic injury, like a fall.

Symptoms of Rotator Cuff Tears

Symptoms of rotator cuff tears include shoulder pain and a crackling sensation (“crepitus”) when moving the shoulder in certain positions. You may feel pain even while the shoulder is at rest, as well as pain and weakness when lifting and lowering the arm. Most people experience significant pain at night and have trouble sleeping, especially when lying on the affected shoulder. If the tear is sudden, you may hear a snapping or popping sound, experience intense pain, and have an immediate weakness when trying to lift your arm.

Tears that develop slowly due to overuse also cause pain and arm weakness. You may have pain in the shoulder when you lift your arm to the side or pain that radiates down your arm. At first, the pain may be mild and only present when lifting your arm over your head, such as reaching into a cabinet. Over-the-counter medication, such as Tylenol or ibuprofen, may relieve the pain initially.

Over time, the pain may become more noticeable at rest and no longer goes away with medication. You may have pain when you lie on the affected side at night. The pain and weakness in the shoulder may make routine activities such as combing your hair or reaching behind your back more difficult.

If you are experiencing any of these symptoms, you should seek medical treatment.

Treatment for Rotator Cuff Tears

Rotator cuff injuries can cause significant shoulder pain and weakness. Proper treatment can help patients regain shoulder strength and function.

Nonsurgical Treatment Options for Rotator Cuff Tears

In many cases, nonsurgical options are initially recommended to treat rotator cuff tears. While a full-thickness rotator cuff tear will not heal without surgery, patients with a partial tear may have positive results with nonsurgical treatment.

Nonsurgical treatment typically involves a combination of rest, activity modification, medications, physical therapy, and possibly a cortisone injection.

While nonsurgical treatment effectively relieves pain for many patients, there is a possibility that the tear may get larger without surgical repair. Patients may need to modify their activities to reduce that risk. For this reason, many patients often move forward with surgical repair of a torn rotator cuff so that they can return to full activities and sports without pain after recovering from the surgery.

Surgical Treatment Options for Rotator Cuff Tears

Surgery may be recommended if nonsurgical treatment does not relieve symptoms or in the event of a full-thickness tear in the shoulder.

Dr. Jurek performs rotator cuff repair surgery arthroscopically in the vast majority of cases but may perform open surgery for certain large or complex tears.

Arthroscopy involves using a small, specialized camera and lens to view the structures of the shoulder and additional specialized instrumentation to reattach the torn rotator cuff tendon(s). The arthroscope is inserted into the shoulder through small incisions and displays images of the internal shoulder structure on a monitor. This allows Dr. Jurek to repair the rotator cuff tear using much smaller incisions (a couple of millimeters) than would be required with open surgery. This approach often results in less pain after surgery and an excellent recovery.

On rare occasions, the rotator cuff tear is so severe that it is irreparable. In these cases, a superior capsular reconstruction with a dermal graft may be needed. If the patient also has severe arthritis in the shoulder with a massive rotator cuff tear, a reverse shoulder replacement may be necessary.

Recovery After Rotator Cuff Surgery

Patients who undergo rotator cuff repair surgery typically are in a shoulder immobilizer or sling for 6 weeks after surgery while the repair heals. During these first 6 weeks, no active motion or use of the shoulder is permitted. Gentle activities such as writing and typing are allowed as long as the patient is comfortable. Gentle passive motion (where the operative arm is moved with the non-operative arm) is also allowed. Full gentle range of motion of the elbow, wrist, and fingers is allowed and encouraged to avoid stiffness and discomfort.

Return to most activities after rotator cuff repair surgery takes approximately 5-6 months, while complete recovery from rotator cuff surgery takes about 10-12 months. The majority of patients have greater shoulder strength and less pain following recovery.

Physical therapy and strengthening exercises are an essential part of recovery. Rehab begins with passive motion exercises, which can start after the first postoperative follow-up visit (usually 7-10 days after surgery). After approximately 6 weeks, patients progress to active motion exercises and gradually build up to strengthening exercises.

Rotator Cuff Tear Treatment in Seattle, Washington

Dr. Jurek is here to assist you every step of the way in treating your rotator cuff tear. If you have any questions about rotator cuff repair surgery and would like to schedule an appointment, please call Dr. Jurek at (206) 386-2600. You may also request an appointment online.

Rotator Cuff Repair FAQs

Is there a difference between an arthroscopic and open rotator cuff repair?

While the incisions are much smaller with an arthroscopic rotator cuff repair procedure, it is important to remember that the same tissues are still repaired with both techniques. Thus, the same postoperative precautions regarding tissue-healing time for the repaired tendon(s) are observed with each technique.

How should I manage my surgical site and dressings?

The dressings covering your surgical incisions are waterproof and may be left in place until your first postoperative follow-up visit. You may shower after surgery when you feel ready. Take your shoulder immobilizer off and hold your arm to your abdomen or let it gently hang to your side. You can also use a sling and let it get wet in the shower if that is more comfortable. If your dressings become wet or saturated, it is okay to remove them and replace them with sterile bandages/band-aids once your skin has dried. Do not soak in a tub or hot tub while your incisions are still healing.

Do I need to wear a sling/immobilizer after surgery? If so, how long do I wear it, and when can I take it off during the day?

Generally, you should wear your immobilizer or sling at all times except for gentle range of motion exercises and showering for approximately 6 weeks. The time period can vary slightly depending upon the size of your tear and thus the extent of the rotator cuff repair.

You may remove the immobilizer or sling for exercises, icing, dressing, and showering as prescribed by Dr. Jurek or your physical therapist. If you are sitting quietly at rest, it is okay to loosen or remove your immobilizer or sling but you should wear it when you are up and moving around.

Are there any precautions regarding movements and positions after surgery? What movement and positions should I avoid?

Do not actively move your arm away from your body for 6 weeks following surgery. In addition, do not use your operative arm to lift or move any object.
Follow Dr. Jurek’s and your physical therapist’s directions regarding specific motions or positions to avoid after surgery as your repair heals (different tendon repairs necessitate different restrictions).

Many patients find that lying on a wedge pillow in a bed or sleeping in a recliner is more comfortable than lying flat in bed. See the Things to Do Before Surgery section for more information and tips on sleeping after a rotator cuff repair surgery.

Can I use my operative arm for dressing, bathing, driving, and other daily activities? How should I manage my arm in the shower?

While keeping your arm to your side, you may gently use your wrist, hand, and elbow for daily activities. This includes eating, shaving, and dressing, as long as you do not move your operated arm away from your body, you are not exerting force with your arm, and the movement/activity does not increase your pain.

Do not use your arm to push up/off the bed or chair for 6 weeks after your surgery.

When using your keyboard and mouse, do not move your arm away from your body, instead, use your immobilizer or a pillow to support your arm.

When showering, you may wash under the involved armpit by bending forward to let your operative arm hang freely and reaching under with the opposite arm. Take your shoulder immobilizer off and hold your arm to your abdomen or let it gently hang to your side while in the shower. You can also use a sling and let it get wet in the shower if that is more comfortable.

Do not actively move your arm away from your body, instead, use your other arm to lift and support your operative arm.

When should I begin formal physical therapy? How often do I need to go?

Physical therapy can usually be initiated after the first postoperative visit (usually 7-10 days after surgery). Therapy performed within the first 6 weeks after surgery will focus primarily on very gentle passive range of motion and secondary issues like scapula and neck discomfort. Active range of motion exercises typically start 6 weeks after rotator cuff repair surgery and strengthening exercises usually begin 3 months after surgery.

It may be beneficial to attend a couple of physical therapy sessions within the first 6 weeks following surgery and then attend weekly or twice weekly starting at the 6-week mark.

Many Seattle physical therapy clinics are quite busy, and Dr. Jurek recommends contacting the PT clinic ahead of time to schedule your appointments based upon the timeline above. Dr. Jurek is happy to provide physical therapy recommendations if needed.

When can I start strengthening exercises?

Typically, strengthening exercises do not begin until 12 weeks after surgery. Sometimes strengthening exercises are delayed until 16 weeks after surgery.

Are there any medications that I should not take during my recovery/rehabilitation?

You can take Tylenol or any of the pain medications Dr. Jurek prescribes. Also, frequent icing of your shoulder (see Cold Therapy Options for more information) will assist with pain management. Some research points to the possibility that non-steroidal anti-inflammatories (Ibuprofen, Motrin, Aleve, Advil, etc.) may hinder tendon healing. Hence, it is best to take these medications sparingly while your rotator cuff repair heals.

When can I return to sports and recreational activities?

Generally, you can return to most sports and recreational activities within 5 to 6 months after surgery.

Always seek permission from Dr. Jurek and your physical therapist before starting any sports-related activity.

Can I smoke following surgery?

You should not smoke or use tobacco products before or after surgery as it significantly hinders tendon healing and also significantly increases your risk of infection after surgery. Talk to Dr. Jurek about your concerns with smoking and about strategies to quit before your surgery to optimize your chance of a full recovery after surgery.

Will I progress just like my friend who had rotator cuff repair surgery?

Can I smoke following surgery?

Every shoulder is different, and every rotator cuff tear is unique. Patients who undergo rotator cuff repair surgeries on both of their shoulders typically have different recovery timelines and experiences unique to each shoulder, and so it is likely that you will not progress just like your friend who had cuff repair surgery.

In general, however, most patients feel that they have achieved significant recovery to the point where they can do most of their preinjury/presurgery activities at around 6 months after surgery. Athletes returning to high-level activities such as contact sports or heavy lifting will gradually build up to these activities over 8 to 12 months. Most rotator cuff repair surgeries take approximately 1 year before full recovery is achieved and the repair is completely healed.

Does nutrition impact my outcome after rotator cuff repair surgery?

A healthy, well-balanced diet improves your ability to heal after rotator cuff repair surgery. Many Seattle physical therapy groups offer consultations with a nutritionist a couple of weeks before surgery as well as in the weeks following surgery to make sure patients are optimizing their nutrition and thus their recovery. Most insurances cover these services. Dr. Jurek will be happy to provide recommendations if you are interested in learning more.

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Seattle, WA 98116
(206) 386-2600

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Seattle, WA 98122
(206) 386-2600

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