The Low Down on Rotator Cuff Tears

When to see your orthopedic specialist

By Susan Tulino

What’s one thing a baseball player and a window cleaner have in common? Both are at increased risk of a rotator cuff tear while on the job due to continuous movement of the shoulder joint.

Shoulders are the most mobile joints in the human body and allow a wide range of movement. They are powered by a group of 17 muscles, including deltoids, but rotator cuffs – the four tendons surrounding the ball and socket joint of a shoulder – play an important role in our shoulders’ fine movements and functionality. Tears to the rotator cuff can occur either due to an acute injury or long term wear and tear.

Kevin Peltier, MD, surgical services director at Haymarket Medical Center, a Novant Health UVA Health System facility, helps us understand the difference between the two types of tears and when to see a doctor.

Acute Tears

Acute tears occur when people with otherwise “normal” shoulders have an injury, most commonly caused by reaching out and grabbing onto something to stop a fall. However, everyday movements such as shoveling snow or picking up a box that is slightly too heavy can also cause acute tears. Sports or jobs requiring a lot of overhead movement and use of the shoulder muscles and tendons can put people at higher risk.

“Acute rotator cuff tears often cause immense pain and prompt people to seek a physician’s evaluation right away, which is good because these types of tears should be evaluated and treated early,” says Dr. Peltier. “About 80-95 percent of people in this category will end up needing surgery to repair their tears, so the earlier it is seen and treated, the better.”

Dr. Peltier added that the recovery process for rotator cuff surgery is a lengthy one, often taking up to nine months for shoulders to regain full functionality.

Chronic Tears

The more common type of rotator cuff tear is chronic tears, which happen over time due to wear and tear on the tendons. Much like car engines over years of use require tuneups, physicians frequently see patients with rotator cuff pain as they age.

“Some studies show that by age 80, 50 percent of people will experience some sort of rotator cuff injury. With chronic tears, we see patients whose shoulder pain gradually increases until they decide it’s time to have it evaluated,” says Dr. Peltier. “Fortunately, many of these are partial tears that do not require surgery, but can be managed and treated in other ways.”

Treatment for chronic rotator cuff tears can include physical therapy, cortisone injections to relieve pain and inflammation, and/or small lifestyle changes that put less impact on the shoulder joint.   

The only way to fully heal a torn rotator cuff is through surgery, Dr. Peltier advises, but it is often possible to forgo surgery and instead manage pain. Plenty of people live with normal shoulder function even with partial tears.

When To See Your Doctor

“When you hear popping or crackling noises in your shoulder or other joints, it isn’t necessarily an indication that there is a tear,” says Dr. Peltier. “Noises and discomfort can also be caused by bursitis or inflammation. In any case, it’s good to pay a visit to your doctor if you’re concerned.”

If it turns out the discomfort is caused by a tear in your rotator cuff, your physician will work with you to determine the best treatment plan to get you back to full functionality.

“Every person that has a rotator cuff problem will need individualized treatment based on their expectations, the size of the tear, individual limitations and pain levels. There is no one-size-fits-all treatment,” says Dr. Peltier.

Novant Health UVA Health System has a specialized team of orthopedic and sports medicine providers to diagnose and treat shoulder injuries, in addition to other joint injuries. On occasion, these providers also offer their time to help educate the community. Dr. Peltier will present an orthopedic lecture on shoulder pain and treatment options on Wednesday, May 15 from 6:30-8:30 pm at Haymarket Medical Center in Community Rooms A and B.

To learn more please visit: novanthealthuva.org/services/orthopedics–sports-medicine.aspx.

To schedule an appointment with an orthopedic expert, please use the “Find a Provider” page.

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