Shoulder pain is a common problem, especially with older people. While shoulder pain may be caused by a multitude of underlying issues, one of the most common causes are injuries to the rotator cuff.
The American Academy of Orthopaedic Surgeons reported that nearly 2 million people in the United States visited their doctor for a rotator cuff problem in 2008.
The rotator cuff is a network of four muscles that form a covering around the head of the upper arm bone, helping to keep the arm in the shoulder socket. The rotator cuff helps to lift and rotate the arm, so when injured or torn, it can make daily activities like getting dressed, sleeping and raising the arm difficult.
Several factors contribute to rotator cuff tears, including lack of blood supply and overuse. The blood flow to the rotator cuff diminishes as people age, leaving it susceptible to injury and tearing.
Repetitive stress, caused by repeating the same motions over and over, can also result in rotator cuff injuries, including tears. As a result, most rotator cuff tears are a result of a slow degeneration of the rotator cuff muscle/tendon.
Treatment for rotator cuff tears can include a variety of options, from physical therapy to shoulder replacement. The type of treatment required will depend on a number of factors, including tear size, patient age and activity, and whether the patient has shoulder arthritis.
Patient age is one of the most important factors in determining whether surgical repair will help heal the tendon. Studies show that as a patient’s age increases into the late 60s and 70s, the reliability of a tendon healing declines.
Surgery for a rotator cuff tear may include an arthroscopic (minimally invasive) procedure or reverse total shoulder replacement. Most commonly, arthroscopic techniques are used to repair a tendon back to its normal attachment point on the humerus, a long bone in the arm.
Arthroscopic rotator cuff debridement is often reserved for older, low-demand patients with non-repairable, large rotator cuff tears and adequate shoulder range of motion. The procedure trims the torn portions of the rotator cuff tendon in order to remove some of the tissue that is causing pain.
Reverse total shoulder replacement is used in older patients with irreparable, large rotator cuff tears and an inability to elevate their arm above shoulder height. This procedure is also used for patients with shoulder arthritis and associated rotator cuff tears. During this surgery, the position of the ball and socket is changed, which alleviates pain and increases shoulder range of motion.
Persistent and significant shoulder pain is a common ailment that most frequently is a consequence of age-related changes in the shoulders. Fortunately, a majority of the patients who suffer will not require surgery. If you are experiencing shoulder pain or suffering from an injury, talk to your physician about options to help alleviate the pain.
Dr. Ryan Donegan is with Bluegrass Orthopaedics and Hand Care.