Rotator cuff injury common, leading to pain or weakness in joint

Early one morning last August, Donna Przezdziecki of Glenville missed the last step and fell on her left shoulder, after going upstairs to check on her granddaughter.

“I tried to nurse it back to health myself, but it didn’t really work,” said Przezdziecki. “I really didn’t have a lot of pain, but I had no strength. I could hardly lift up a pen or a coffee cup, and I’m left- handed.”

Five weeks later, she went to see Dr. Eric Aronowitz at Schenectady Regional Orthopedics, where she learned she had torn her rotator cuff.

“The rotator cuff is a group of four muscle tendon units that form a cuff around the shoulder joint,” explained Aronowitz.

They connect your upper arm bone (humerus) with your shoulder blade and help hold the ball of your upper arm bone firmly in your shoulder socket, as if holding a golf ball on a tee. The combination results in the greatest range of motion of any joint in the body.

“It’s the most common shoulder problem that we see,” said Aronowitz.

Causes and symptoms

Causes of injury may include falling, lifting and repetitive arm activities, especially those done overhead. The injury is also common among people whose job or hobbies include heavy demands on their shoulders such as athletes, archers and people in the construction trades.

Poor posture, especially as related to your shoulders hunched forward, can also contribute to rotator cuff injury. As you get older, your risk of rotator cuff injury increases.

The most common sign that someone has a problem is pain and tenderness in your shoulder, especially when reaching overhead, reaching behind your back, lifting, pulling or sleeping on the affected side.

“Most people can localize the pain to the upper arm. So typically it’s not pain deep in the shoulder,” said Aronowitz. “It’s usually on the outside part of the arm.”

If you have a severe injury such as a large tear, you may experience continuous pain and muscle weakness.”

A rotator cuff injury involves any type of irritation or damage to your rotator cuff muscles or tendons, including:

— Tendinitis. Tendons in your rotator cuff can become inflamed from overuse or overload. In some people, the space where the rotator cuff resides can be narrowed because of the shape of the different shoulder bones, including the outside end of the collarbone or shoulder blade.

— Bursitis. The fluid-filled sac (bursa) between your shoulder joint and rotator cuff tendons can become irritated and inflamed.

— Strain or tear. Left untreated, tendinitis can weaken a tendon and lead to chronic tendon degeneration or to a tendon tear. Stress from overuse can also cause a shoulder tendon or muscle to tear.

Correcting the problem

Diagnosis of a rotator cuff problem is partly based on a physical exam.

“We look for limitations of motion, strength deficits, and we have tests that will bring on pain,” said Aronowitz.

Doctors may also recommend diagnostic imaging tests such as X-rays or an MRI.

Most of the time if someone has bursitis or tendinitis, physical therapy is the first line of treatment.

“By strengthening the rotator cuff, typically, symptoms will resolve or improve,” said Aronowitz.

Depending on the severity of the pain, your doctor may use a corticosteroid injection to relieve inflammation and pain.

If conservative methods fail, surgery is an option.

There are several surgical procedures that are possible for rotator cuff treatment. The three most common procedures include:

— Open repair: Prior to the use of the arthroscope, all rotator cuffs were repaired by looking directly at the torn tendon through an incision about 6 to 10 centimeters in length. The advantage is the rotator cuff tendons are easily seen by this method, but the incision is large, and the recovery can be longer and more painful.

— Mini-open repair: The mini-open repair method involves both the use of an arthroscope and a short incision to get access to the torn tendon. By using the arthroscope, the surgeon can also look into the shoulder joint to clean out any damaged tissue or bone spurs. The incision is about 3 to 4 centimeters, and recovery is less involved than the open cuff repair.

— Arthroscopic repair: An arthroscopic repair is done with small incisions, and the repair is done by the surgeon looking through a small camera to watch the repair on a television monitor. Not all type of tears can be treated by this method.

Getting back to normal

“Whether the surgery is done arthroscopically or through a mini-open, the postoperative protocol is going to be the same,” said Aronowitz. “We typically fix the tear with metal anchors and sutures, which puts the tendon back where it belongs. But it’s really the tendon scarring back down to the bone that’s going to give it the ultimate strength.”

Postoperatively, people are treated in a sling for six weeks to allow the tendon to heal back to the bone.

To help regain range of motion, mild physical therapy usually starts two weeks following surgery. Active range of motion and rotator cuff strengthening exercises start six weeks following surgery once the sling is discontinued.

“Typically, it takes four to six months for recovery, although every patient is different,” said Aronowitz. “By strengthening the rotator cuff, there is less of a chance that you will impinge the bone above it, which causes the bursitis and tendinitis.”

Przezdziecki, who is in excellent shape and works out in a gym every day, had mini-open repair surgery in October, followed by several weeks of physical therapy and doing exercises at home.

“It feels great now,” said Przezdziecki. “I’m back at the gym and even lifting a little heavier weights now.”

Aronowitz said while most people can do the majority of things they want to in four to six months, it takes some people a year to fully recover from surgery.

Aronowitz stressed that rotator cuff tears should be repaired.

“What can happen over time is the tendon will retract farther and farther away from the bone, and as it retracts it will scar in and get to a point where you have a tear that can’t be repaired,” said Aronowitz. “It doesn’t happen often, but every once in a while I have to tell someone I can’t fix it.”