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Rotator Cuff Injury: Symptoms, Diagnosis and Treatment

Dr. Joel Weber discusses the symptoms, how to diagnose and treat a rotator cuff injury.
Rotator Cuff Injury: Symptoms, Diagnosis and Treatment
Featuring:
Joel Weber, MD
Joel Weber, MD is a Physician and Surgeon at EvergreenHealth Orthopedic & Sports Care, Monroe.
Transcription:

Caitlin Whyte: Welcome to Check-Up Chat with EvergreenHealth. I'm Caitlin Whyte. And today, we're sitting down with Dr. Joel Weber to talk about rotator cuff injuries and treatments. He is a physician and surgeon at EvergreenHealth Orthopedic and Sports Care Monroe. So doctor, start us off with what the rotator cuff is and what it does.

Dr. Joel Weber: Yeah. I think what the rotator cuff is a very common question that I get from patients quite frequently. The rotator cuff is actually a group of four muscles that surround the ball and socket joint of the shoulder. They each have individual names being the supraspinatus, infraspinatus subscapularis and teres minor.

The function of the rotator cuff is really to stabilize the ball of the shoulder onto the socket as your shoulder moves around in space. So it really assists moving your shoulder in rotation, reaching and overhead type activities, which obviously is very important for any part of life and any sort of athletic activity.

Caitlin Whyte: So what causes a rotator cuff to tear?

Dr. Joel Weber: And so rotator cuff tear is again a common thing that we see in orthopedic practice. They really come in two flavors. Initially, traumatic tears are tears that are caused by some sort of injury. This can be an injury like a car accident or motorcycle accident. It can be a sports injury. It can also be from everyday activities, lifting heavy objects or working out at the gym.

The other type of rotator cuff tear is more of a chronic or degenerative tear. And we think these occur by either slow wear and tear that accumulates with time. Sometimes it can be associated with a concept of shoulder impingement where the rotator cuff is rubbing on a bone spur. Other types of chronic tears are just again degenerative and come with age and activity over multiple years.

Caitlin Whyte: So, you know, I'm at home. My shoulder hurts. How do I know when that pain is just a simple strain, that'll kind of heal on its own or when I should come in and see my doctor?

Dr. Joel Weber: Also a great question and I think, you know, anybody who's been living on earth for a few decades has had some shoulder pain at some point or another. So, the red flags that we're really looking out for from an orthopedic standpoint are if a significant traumatic event led to the shoulder pain. You know, if there was a single event where your shoulder was normal and then you had an injury and it's not normal, that's a red flag that there may have been a soft tissue injury or a rotator cuff injury.

Most mild shoulder strains, we would expect the symptoms to get better over about a week, especially if you're doing the regular treatments like resting, icing, you know, taking some over-the-counter medication. If they're not getting better over a week or so, usually that can be a reason that something is going on in the rotator cuff.

Symptoms that are more specific for rotator cuff injuries that we looked out for, pain in the shoulder with any sort of overhead activities, reaching above shoulder level or above your head. Pain at night is often indicative of rotator cuff problems. Nighttime pain that keeps people up makes it uncomfortable to sleep. And then obviously, any associated weakness. The rotator cuff again is a group of muscles, so injury through the muscles can cause pain, but obviously weakness with lifting and reaching type activities.

Caitlin Whyte: Now, doctor, is there any way to prevent a rotator cuff tear from happening?

Dr. Joel Weber: There are some. You know, when we look at rotator cuff tears, we really look at risk factors of what leads to them. And we found some of these risk factors are modifiable or can be changed. And some, unfortunately, you know, it can't be changed. And so one risk factor is age. And that, unfortunately, we can't really modify or change in patients. But we know that, you know, once we hit an age of 60 to 70 years old, up to a third or a half of patients may have some form of rotator cuff disease or tear.

Other risk factors that may lead to rotator cuff tears, smoking. We know that any sort of nicotine can limit the blood supply to the rotator cuff and thus cause weakening and lead to tears. And we also find, you know, tears that correlate with people who have cholesterol problems, as well as a family history of tears, people who have mothers, fathers, grandparents who have rotator cuff problems may also be at increased risk for rotator cuff problems. So to prevent them, you know, we just talk about limiting smoking, maintaining good general health, and obviously trying to avoid any sort of traumatic injury.

Caitlin Whyte: Well, unfortunately, tears do happen. How important is rehabilitation in the treatment of a rotator cuff tear?

Dr. Joel Weber: You know, we're learning more and more here with new orthopedic research, just about the body's ability to heal or regenerate tears and rehab is extremely important not only in treating tears without surgery, but also in helping the healing process after surgery.

So we know that, you know, specific shoulder physical therapy can do a lot to help strengthen a torn rotator cuff. It can not only strengthen the muscle and tendon that is injured, but also strengthen the neighboring muscles and the muscles that allow us to compensate. And so there is a plethora of research out there showing that patients with rotator cuff tears can get better with physical therapy. And it is an avenue to avoid surgery in specific instances.

Caitlin Whyte: Now, if someone has a rotator cuff injury and they keep using it, you know, maybe they still think it's that strain, will this cause further damage?

Dr. Joel Weber: I think we have some data on that. And the answer is sometimes yes. So we know that about 50% of rotator cuff tears that are full thickness, which is a larger variant of them, will progress at about two years. And our thought is that the bigger the tear, the more likely it is to progress and the faster it is to progress.

So if you have a rotator cuff tear, the counseling we usually provide to patients is that, you know, it may progress with time. There are ways to modify what you do and avoid certain activities to try to slow that progression. But at the very least, it's a reason to maintain good followup with your orthopedic surgeon, just to make sure that it's not progressing and not getting worse to the point where you'd be talking about treatment beyond rehab like surgery.

Caitlin Whyte: And wrapping up here, when does the conversation shift to surgical options?

Dr. Joel Weber: It has a lot to do with the type of tear, the size of the tear and the patient. Obviously, we treat everybody as an individual and each case is a little different. Certain types of tears are more likely to progress to need surgery faster, those types are traumatic tears. Again, somebody who had a normal rotator cuff, which was injured through trauma and now is not functioning well, as well as larger, full thickness tears, the rotator cuff can partially tear or it can fully tear. The full tears are more likely to need surgery.

But beyond that, there is a population of patients that despite extensive rehab. They don't get better. They have persistent pain and weakness. So people who fail conservative management, including formal physical therapy are ones that we talk to about surgery as being an option to help them.

Caitlin Whyte: Great. Well, Dr. Weber, is there anything else we didn't touch on that you want to add?

Dr. Joel Weber: I think rotator cuff tears are extremely common. I think it's something we run into in all ages. So it's definitely something to be on a lookout for as people continue to be active throughout the world. And again, there's multiple treatment options for them. So we're always happy to discuss those with patients and help them on the road to getting better and staying active.

Caitlin Whyte: Well, this has been a great conversation, Dr. Weber. Thank you so much for being with us today.

To learn more or make an appointment, please visit us online at evergreenhealth.com. Please also remember to rate, review and subscribe to this podcast and share it with your loved ones. Be sure to listen to Dr. Weber's next podcast coming up soon, What to Expect From a Rotator Cuff Surgery. That will be available right here on Check-up Chat with EvergreenHealth. This has been Check-up Chat with EvergreenHealth. I'm Caitlyn Whyte. Stay well.