Rotator cuff tears and rotator cuff repair

The rotator cuff is a group of four tendons that centers the ball of the shoulder in its socket and powers rotation and elevation. Tears occur either from a discrete injury — a fall, a lifting event, a dislocation — or from gradual degeneration of the tendon where it attaches to bone.

The size and location of the tear matter more than the word 'tear' itself; a small degenerative tear and a large acute retracted tear are different problems with different treatment paths.

Rotator cuff symptoms tend to build over weeks to months when the tear is degenerative, and appear suddenly when the tendon is torn during an injury.

Degenerative tearing is the most common pattern, developing where the tendon attaches to bone and becoming more frequent with age. Traumatic tears occur with a fall onto the arm, a heavy lift, or after a shoulder dislocation.

Repetitive overhead work and overhead sport increase the load on the cuff, and smoking and diabetes are associated with poorer tendon quality and healing.

Prompt evaluation is worthwhile when weakness follows an injury, when the arm cannot be raised, or when pain persists beyond several weeks of rest and activity modification. Tears that are left to retract and the muscle that becomes fatty over time can become unrepairable, so acute injuries in active patients are best seen early.

Evaluation starts with the history and a physical examination that tests each part of the cuff individually, along with the biceps tendon and the shoulder joint itself. X-rays are obtained to assess the bone, joint space and any arthritic change. MRI is used when the examination suggests a structural tear or when non-operative care has not worked, because it defines tear size, tendon retraction and muscle quality — the factors that determine whether repair is likely to hold.

Many patients are treated without surgery. A rotator cuff program focuses on restoring motion, then rebuilding the strength of the remaining cuff and the scapular stabilizers so the shoulder can function despite the tear. Activity modification, anti-inflammatory measures and a corticosteroid injection can each play a role.

This path is reassessed on a defined timeline rather than continued indefinitely. If pain and weakness persist, or if the tear pattern is one that tends to enlarge, repair is discussed.

Arthroscopic repair is performed through several small incisions with a camera inside the joint. The torn tendon is mobilized and brought back to its attachment on the humerus, where it is secured with suture anchors placed in the bone. Associated findings — biceps tendon pathology, labral tearing, bone spurs contributing to impingement, or arthritis at the AC joint — are treated in the same setting when they are contributing to symptoms.

Surgery is usually outpatient, under general anesthesia with a regional block for post-operative pain control.

The biology of tendon healing to bone sets the pace of recovery, and the early phase is deliberately protective. A sling is used for a period of weeks; passive and assisted motion begins early to prevent stiffness, with active motion and then strengthening added in stages.

Recovery is measured in months rather than weeks, and progress is judged by motion, strength and comfort rather than by the calendar alone. Written protocols are provided so you and your therapist are working from the same plan.

Dr. Horner is a board-certified orthopedic surgeon with fellowship training in sports medicine and shoulder surgery at Rush University Medical Center, and he has cared for professional athletes in Chicago. Rotator cuff problems are a core part of his practice, and non-operative care is offered as seriously as surgery when it is the better option.

Patients are seen at Oak Brook on Mondays, Little Village on Wednesdays and St. Charles on Thursdays.