What are they? What is the right treatment for your rotator cuff? Why did your brother-in-law get surgery for his and you are only doing therapy?
If you’re reading this you may already know how painful rotator cuff tears are. You yourself may have difficulty sleeping or lifting your arm overhead. You probably also recognize that rotator cuff injuries are common conditions – everyone knows someone or has a favorite sports figure with a rotator cuff problem. You might recognize that people are often treated differently for rotator cuff injuries: some people get surgery right away, some get injections then surgery; still others only do physical therapy and never get surgery.
There may not be a more confusing shoulder problem for patients than rotator cuff tears. Why should this be? If it’s torn, you fix it, right? The simple answer is: not always.
Let’s start with a definition. “Rotator cuff “is a term used to describe a group of 4 muscles and tendons that envelope the ball and socket shoulder joint. They are critical for strength, shoulder balance and for helping to keep the ball in the center of the socket.
One reason why rotator cuff tears are confusing is that they are not really one entity. Your brother-in-law’s tear is not necessarily the same as your tear.
Each tear differs depending on the quality of the tissue, the size of the tear, how long it’s been torn, the pattern of the tear, and what part of the rotator cuff it occupies. All of these factors play a role in determining an appropriate treatment plan for your particular rotator cuff tear.
Some tears are best treated with immediate surgery. Some are better off left alone. Still others are a “red herring,” found only on over-zealous testing. The fact remains that while they may be similarly painful, each tear’s unique character will dictate the right treatment course for you.
MRI’s don’t always help you
It is ironic that MRIs can sometimes confuse you more than enlighten you about a rotator cuff tear. Why? While MRI is a wonderful tool and certainly does a nice job of visualizing most anatomy, taken out of context, MRI reports can sometimes give you an overly alarming description of the structures inside your shoulder.
An example is the middle aged adult with gradual onset of shoulder pain. Often this person will come referred to me already scared, with an ominous sounding MRI report in hand. The report usually says something to the effect of “rotator cuff tendinosis, possible partial thickness rotator cuff tear.” Sounds scary. The patient is worried about the ominous sounding “tear.”
The problem is that normal changes that come with age can often appear similar on an MRI to “partial rotator cuff tears.” Thus an MRI report that reads “possible partial rotator cuff tear” may just be a “normal” MRI for some people.
Additionally, just because the report states that you have a tear does not always mean that a tear is the source of your pain. Pain can come from multiple sources within the shoulder including weakness, inflammation or stiffness. And while it would be relatively easy to assume that you have to “fix” every tear with surgery, it may not be the most appropriate course of action for you.
Just be careful about reading too much into an MRI report. They sometimes are laced with long and intimidating descriptions of essentially “normal” findings. Only when these findings are put into context can you make a good decision about whether your rotator cuff tear warrants treatment.
In the end, the best decision about how to treat your shoulder pain should involve a thorough history and physical with a competent specialist and a mutual discussion between you and your doctor. Imaging tests can aid in this discussion but cannot replace it.
If you are confused about your rotator cuff tear or rotator cuff injury and want more information or time with a shoulder specialist to understand your options better, please call for a personal consultation:
Dr. DiPaola is adept at the proper non-operative rehabilitation and operative treatment of rotator cuff injuries. He has performed hundreds of rotator cuff operations and is well versed with minimally invasive techniques should surgery be necessary. He also has experience treating difficult to manage rotator cuff problems such as large tears, old tears, repeat tears and rotator cuff tears associated with arthritis.