What are the treatment options for rotator cuff tears? First and foremost, what is the rotator cuff? It’s a group of four tendons all of which come from muscles that originate on the scapula or shoulder blade. The tendons then attach to the “ball” of the shoulder joint forming about 1/2 of a shirt sleeve cuff from the front to the back of the “ball”. The two middle tendons on the top of the ball are the one’s usually torn. If you’re under forty years of age you probably don’t have a rotator cuff tear, i.e., the older you are the more likely the diagnosis. The under forty crowd most likely has rotator cuff tendinitis or, if injured, a shoulder separation, dislocation, or labral tear. Middle-aged patients(forty to sixty years old roughly) tend to tear the rotator cuff after injuries whereas degenerative tears are more likely the older one gets. On the job rotator cuff tears are quite common.
Treatment options are conservative or nonsurgical, and surgical. I treat most of my younger very active patients with surgery simply because they rarely respond to injections and physical therapy. Surgery has a high success rate generally especially in healthy nonsmoking patients and many of these patients can resume normal activities and work several months after the repair. Rotator cuff surgery is easier and more likely to be successful if I can do the repair less than six months after symptoms begin. Repeat surgery is required in less than 10% of patients.
Older patients have a much better chance of responding to injections, physical therapy, home exercises, activity modification, and “wait and see” treatment.
Hope this helps. Thanks for your time.
Mark Harriman, M.D.