Orthopedics

OSPI offers the top orthopedic surgeons in Gilbert AZ and the East Valley. Drs. Mahoney, Macqueen, Stewart and Clouse offer minimally invasive General, Sports and Joint Replacement expertise.

Physical Therapy

Whether you are pre or post-operative, OSPI’s East Valley physical therapy team works with you on both active and passive treatments. Your will be in the best hands with our licensed physical therapists!

Chiropractic

The Gilbert chiropractors at OSPI offer a plethora of nonoperative pain relief options such as manipulations, laser therapy, physiotherapy and electrical stimulation.

Family Practice

OSPI offers comprehensive family practice services including allergy testing, BHRT, medical weight loss, aesthetics and full check ups.

Medical Weight Loss

Patients routinely experience dramatic, healthy weight loss with the customized programs at OSPI. The programs combine nutrition, exercise and prescription weight loss options.

Performance Training

OSPI’s integrated team of healthcare providers work with both amateur and professional athletes to maximize one’s performance with sport specific programs.

Pain Management

OSPI’s Board Certified, Fellowship Trained pain doctor offers both medication management and interventional procedures with exceptional outcomes!

Rotator Cuff Tears

FAQS on Rotator Cuff Tears

 

Over 2 million Americans feel the pinch of shoulder pain associated with rotator cuff tears each year. The worst nightmare of baseball pitchers, tennis players, boxers, swimmers, and weightlifters impacting their strength, the distressing pain is the most common type of shoulder injury in adults. In your daily life, rotator cuff tears prevent day-to-day activities, as the nagging pain surfaces every time you raise your hand overhead, throw something, or even move your shoulder.

What is the rotator cuff? Why is it important?

The rotator cuff is a supporting structure comprising “four muscles and their tendons” located around the shoulder joint. The “cuff-like” structure is connected to the upper arm “ball” to complete the shoulder socket.

Its primary function is to keep the shoulder joint attached to the arm and assist in its movement forward, backward, upward, and in circles.

What is a rotator cuff tear?

Rotator cuff tear refers to damage in any of the muscles or tendons in the structure. The tear usually results in inflammation of the outermost edge of the shoulder joint known as acromion, as the damaged tendon fails to remain attached to the joint properly and perform smoothly. Recurrent stress cause further injury as the tear widens and worsens.

A rotator cuff tear may be any of the following types:

  • Partial tear impacting a small area or causing minor injury to a soft tissue
  • Full-thickness tear that tears apart a soft tissues or punches it through causing complete damage
  • Acute tear that occurs suddenly and accompanies severe pain usually followed by serious shoulder injury
  • Degenerative tear associated with rotator cuff muscle weakness and wearing down as age progresses

What are the symptoms of rotator cuff tear?

Rotator cuff tear symptoms vary from person to person. One suffering from the disorder is likely to have one or more of the following symptoms.

  • Starts with shoulder weakness and sporadic pain and becomes chronic with the passage of time
  • Recurrent pain in the shoulder whenever you try certain activities
  • Dull shoulder ache when lying on it
  • Pain limiting movement of arm
  • Weakness in shoulder muscle
  • Limited ability to rotate the shoulder
  • Nagging pain when the arm is lifted or moved overhead
  • Cracking sound when the arm is moved or placed in certain postures
  • Intense pain following stress or sudden pressure on the shoulder due to fall or any activity
  • Weakness in the upper arm whenever there is any stress impacting the shoulder

What causes rotator cuff tears?

Medical studies trace rotator cuff tear injury to following causative factors.

  • Stress: Incessant strain and stress may lead to inflammation of tissues in rotator cuff muscles and tendons. The inflammation expands over time leading to tears and damages the cuff. Even lifting heavy objects may lead to soft tissue inflammation that progresses and becomes tears in the rotator cuff.
  • Degeneration of muscles: The unstable nature of the shoulder makes rotator cuff tears a common recurrence. Muscles and tendons wear and tear more frequently as the age progresses and unless taken care of results in rotator cuff pain.
  • Lack of blood supply: If blood supply to the inflamed tendons is disturbed, tears are likely to occur. The risk is higher when combined with repetitive and degenerative causes, as decreased blood supply inhibits the tendon repair process.
  • Anatomical factors: Acromia shape plays a role in rotator cuff tears. Laterally sloping and curved acromia may not be able to withstand intense sports or mechanical activities and gets injured easily when it is subject to stress.
  • Accidental injury: Shoulder injury due to accident or fall can cause rotator cuff tears.
  • Bone spur: It leads to shoulder impingement and impairs smooth functioning of the tendons. Rubbing of bone spurs with rotator cuff muscle tendons has the potential to cause tears.
  • External factors: Poor balance, smoking, diabetes mellitus, neural overstimulation, and overuse of the arm have the potential to facilitate rotator cuff tears.

Who is at risk of rotator cuff tears?

Age, shoulder shape and posture, body-mass index, and occupation are important elements in causing rotator cuff tears. While strength of shoulder muscles is a deciding factor, occupations that put the shoulder through recurrent stress may also cause the condition. Carpenters, painters, swimmers, baseball players, cricket bowlers, football and tennis players, weightlifters, and those doing jobs requiring frequent lifting or overhead tasks face the enhanced risk.

How is rotator cuff tears diagnosed?

The first step to diagnose rotator cuff tear is to analyze the medical history of a patient and observe symptoms. Physical examination of the shoulder injury and strength is done and patients are asked to have a range of motions to identify the pain factor. Many doctors study symptoms for potential neck pain or pinched nerve disorder.

X-rays, MRI, or ultrasound is also suggested to locate rotator cuff tears in the shoulder. While x-rays help identify bone spurs, MRI is effective in diagnose the extent and duration of a tear and degenerative disorders affecting the rotator cuff.

What are the treatment methods available for rotator cuff tears?

  • Medication

NSAID medications, including ibuprofen and naproxen, are commonly prescribed to treat the pain. These medications help control swelling and lessen the pain at the initial stage. However, these drugs do not provide significant relief for chronic conditions or full-thickness tears.

  • Surgical Intervention

For larger and longer rotator cuff tears, surgery is an option. The procedure helps repair tears or takes out spurs in the edge bone. However, surgery keeps you out of job for an extended period and you have to undergo rehab. Such a surgery has also side effects, such as danger of infection, bleeding, stiffness in the muscle, longer recovery, etc.

  • Conservative Treatment

Be good to your shoulder and give it adequate rest. Avoid putting stress on it and performance of activities that causes rotator cuff pain. Add physical therapy and ice therapy to your pain management method and strengthen the rotator cuff muscles through exercises. But such treatment has limited impact and may restrict the activities for a long time.

  • Non-Operative Pain Management Injections

Advances in the medical field have led to use of injections for semi-permanent pain relief. Minimally evasive, these injections are highly effective and have no side effects. An outpatient treatment, these injections provide relief from pain for months at a time when administered directly to the area of pain at regular intervals and patients can do their daily activities without any limitations.

  • Anesthetic injection: It contains lidocaine or similar anesthetic medication and subdues pain by numbing the inflamed area.
  • Corticosteroid injection: It contains steroid that lessens swelling and inflammation in rotator cuff muscles and tendons and allow them to recover and function smoothly.
  • Hyaluronic acid injection: Hyaluronic acid compounds relieves pain and assists healing of rotator cuff tendons.

References

American Academy of Orthopedic Surgeons

Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears

Williams GR, Rockwood CA, Bigliani LU, Iannotti JP, Stanwood W (December 2004). “Rotator cuff tears: why do we repair them?”. The Journal of Bone and Joint Surgery American Volume 86–A (12): 276

Moosikasuwan JB, Miller TT, Burke BJ (2005). “Rotator cuff tears: clinical, radiographic, and US findings”. Radiographics 25 (6): 1591–607. doi:10.1148/rg.256045203

Matava M. J., Purcell D. B., Rudzki J. R. (2005). “Partial-Thickness Rotator Cuff Tears”. Am J Sports Med 33: 1405

Chung SW, Huong CB, Kim SH, Oh JH (February 2013). “Shoulder stiffness after rotator cuff repair: risk factors and influence on outcome”. Arthroscopy 29 (2): 290–300

Seida JC, LeBlanc C, Schouten JR, Mousavi SS, Hartling L, Vandermeer B, Tjosvold L, Sheps DM (August 2010). “Systematic review: nonoperative and operative treatments for rotator cuff tears”. Ann. Intern. Med. 153 (4): 246–55

Rockwood C. A. Jr., Wirth M. A., Basamania C. (1997). “Nonoperative Management of Full-Thickness Tears of the Rotator Cuff”. Orthopedic Clinics of North America 28: 1

Mantone J. K, Burkhead W. Z., Noonan J. Jr (2000). “Nonoperative Treatment of Rotator Cuff Tears”. Orthopedic Clinics of North America 31 (2): 295–311

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