Rotator Cuff Problems: Should I Have Surgery?

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Wesley Logan
5 years ago
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1 To print: Use your web browser's print feature. Close this window after printing. Rotator Cuff Problems: Should I Have Surgery? Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision. 1. Get the facts 2. Compare your options 3. What matters most to you? 4. Where are you leaning now? 5. What else do you need to make your decision? 1. Get the facts Your options Have surgery, followed by physical therapy. Try other treatment, including physical therapy. Key points to remember FAQs You may be able to stop or reverse early rotator cuff damage without surgery. Try using rest, ice and heat, anti-inflammatory medicines, and physical therapy. If you have symptoms that don't get better after 3 to 6 months, you may need surgery. You may want to think about surgery if you have torn your rotator cuff in a sudden injury and the tear is causing shoulder weakness. But surgery can't fully reverse problems that occur over time with wear and tear of the rotator cuff. Whether you choose surgery or other treatment, you will need rehabilitation and physical therapy. What is the rotator cuff? The rotator cuff is a group of four tendons and muscles in the shoulder. The rotator cuff keeps your shoulder stable and allows you to raise and twist your arm. The shoulder (See figure in appendix) is a joint with three main bones: the upper arm bone (humerus), the collarbone (clavicle), and the shoulder blade (scapula). These bones are held together by muscles, tendons, and ligaments. The rotator cuff helps keep the arm bone in the socket of the shoulder blade.

2 What are rotator cuff disorders? The rotator cuff tendons are a common source of shoulder problems. Over time, normal wear and tear can damage or weaken the tendons. That's even more true if the tendons are overused or if you do repeated overhead arm movements. This age-related wear and tear can cause one or more tendons to rub against the bones. This rubbing is called impingement. It also can be caused by irregularly shaped shoulder bones. Rotator cuff disorders include: Inflammation of the tendons (tendinitis) or the bursa (bursitis). Calcium buildup in the tendons. Partial or complete tears of the rotator cuff tendons (See figure in appendix). Partial tears are common when the rotator cuff is already damaged or weakened. A complete rotator cuff tear in someone with an otherwise healthy shoulder is often caused by a forceful injury, such as during sports or a car accident. Without any treatment either rest and rehabilitation or surgery rotator cuff disorders may get worse. Over time, you may have more pain. You may lose range of motion and strength in your shoulder, making it harder to do your daily activities. What kinds of surgery are done to treat rotator cuff disorders? There are two types of surgery for rotator cuff disorders. They help improve strength and movement, and they also relieve pain. Subacromial smoothing. This removes scar tissue; irregularly shaped bone; and damaged tendon, bursa, and debris from the joint (debridement). Rotator cuff repair. This usually starts with debridement. The repair then involves sewing the torn tendon or tendons together and reattaching them to the arm bone. Surgery may be a good choice for you if both of the following are true: You have severe shoulder weakness. These symptoms have not improved after a period of nonsurgical treatment, including a welldesigned physical rehabilitation program. Sudden tears, such as from a major sports injury or car accident, often are best treated with early surgery. Some kinds of tears (such as very large tears) can't be fixed, especially if you have had them for a long time. But surgery can help relieve pain by removing damaged tissue from the joint. What are the risks of rotator cuff surgery? If your rotator cuff tendons are very weak and frayed, surgery won't work well in holding the tendon together. After surgery, you may need to:

3 Avoid lifting heavy objects. Avoid doing overhead work. Avoid sports or activities that require throwing or over-the-head movement of your arm. Shoulder surgery may relieve some pain and weakness and make it easier to move your shoulder. But it may not restore full strength to your shoulder. This is even more true if you have a severe tear in the tendons or if your tendons are weak. You may still have pain. You may need more physical therapy or even another surgery to relieve it. Surgery poses risks of infection, pain that won't go away, and slow healing followed by stiffness. Also, all surgeries pose some risks, such as irregular heart rhythms (arrhythmias), changes in blood pressure, and heart attack. Surgery isn't a substitute for physical therapy. You need to complete a physical therapy program to have a full recovery after surgery. What are other treatments for rotator cuff disorders? Other things besides rotator cuff problems such as problems in the upper back can cause shoulder pain. Shoulder pain alone without weakness or limited movement isn't a reason to have surgery. You may be able to reverse the early stages of rotator cuff damage without surgery, by: Resting, although gentle movement of the shoulder is advised. Holding your shoulder still for long periods, such as with slings or braces, may cause shoulder stiffness or even a frozen shoulder. Using ice packs, followed by moist heat on the shoulder. Taking anti-inflammatory medicines. Be safe with medicines. Read and follow all instructions on the label. Avoiding positions and activities that hurt your shoulder. After you try rest and gentle movement, physical therapy may help relieve your pain and restore strength and flexibility in weak and stiff shoulders. Physical therapy includes exercises to: Stretch tight shoulders. Strengthen the muscles that move the shoulder. Help you do daily activities without putting too much strain on your shoulder. You may not need surgery if: Your shoulder gets better with physical therapy. You have a torn rotator cuff but you are not in pain. You can do your daily activities. You don't want to do the physical therapy program required after surgery. You have other health problems that may make surgery too dangerous.

4 How does physical therapy help treat rotator cuff disorders? Physical therapy is sometimes used to find out the cause of a shoulder problem and to see if surgery will help. Exercises can help strengthen the muscles around a torn tendon and make up for the weakness there. If your shoulder gets better with physical therapy, you may not need surgery. Whether you choose surgery or not, you will need rehabilitation and physical therapy. If your shoulder joint capsule or tendons are tight, physical therapy can help improve your range of motion and allow your shoulder to move more smoothly. Physical therapy may strengthen the muscles that move your arm and shoulder. Physical therapy helps you learn how to lift and carry objects and do other activities using the muscle groups that aren't hurt. This puts less stress on your injured rotator cuff tendons. Most exercise programs can be done easily on your own at home after you've learned how to do them. In most cases, you can try these exercises for several weeks to see if they help, especially if you have had shoulder problems for some time. Why might your doctor recommend rotator cuff surgery? Your doctor may recommend rotator cuff surgery if: You are young and your tendon tissue is strong and healthy. There is a good chance that your tear will get worse over time. You had a forceful injury to your shoulder, such as during an activity or car accident. You have severe shoulder weakness. You have not gotten better after 3 to 6 months of other treatment and physical therapy. 2. Compare your options What is usually involved? Have rotator cuff surgery You are asleep or numb during surgery. If you have subacromial smoothing or rotator cuff repair using arthroscopy, you may go home the same day as surgery. If you have rotator cuff repair using open surgery, you may stay in the hospital for several days. Your arm will be in a sling for several weeks. After either type of surgery, you will do range-of-motion exercises to loosen up your Try other treatment You rest your shoulder. Gentle movement is recommended so your shoulder doesn't get stiff. You try ice packs to reduce pain and swelling. You try using moist heat during gentle shoulder movement. You take anti-inflammatory medicines to relieve pain. You try physical therapy to help you learn how to lift and carry objects.

5 shoulder. Then you'll continue physical therapy for up to 8 weeks. It may take a few months to recover. What are the benefits? You get relief from your pain. You have improved shoulder strength and movement. You avoid the cost and risks of surgery. You avoid having surgery that you don't need if rest and physical therapy improve the use of your shoulder. You can have surgery later if other treatment doesn't work. What are the risks and side effects? Surgery may not restore full strength to your shoulder. You may need more physical therapy or another surgery. Other risks of rotator cuff surgery include: Pain or stiffness that won't go away. Nerve damage. All surgery has risks, including the risks of bleeding and infection and risks related to anesthesia. Your age and your health can also affect your risk. If you have severe shoulder weakness, rest and physical therapy alone may not help. Without any treatment, rotator cuff disorders may get worse. Over time you may have more pain and may lose range of motion and strength in your shoulder. Personal stories Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide. Personal stories about having rotator cuff surgery These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions. "I recently started swimming, and I think the overhead movements have aggravated my shoulder and caused some tendinitis. I have a lot of pain at night, especially if I roll onto my side. I've talked to a couple of people who have had shoulder surgery, and I really hope that I don't need to. My

6 doctor recommended that I try to rehabilitate the shoulder over the next few weeks. I'm resting it quite a bit, taking anti-inflammatory medicines, and using ice and heat to ease the pain. It seems to be working. Soon, I'll start some exercises my doctor showed me to strengthen my shoulders so that swimming doesn't hurt them." Patty, age 27 "My shoulder has been bothering me for over a year now. The pain sometimes wakes me up at night, especially if I roll onto that side. It's also hard for me to lift things with that arm, even dishes or groceries. I've had some tests that showed a tear in one of my rotator cuff tendons. My shoulder moves better after physical therapy, but it is still weak. My doctor is reasonably sure I will have more range of movement and less pain with arthroscopic surgery, as long as I am committed to doing all I can to prevent more problems and to following through with physical therapy. I think I can manage a long-term rehab program." Jennifer, age 47 "I've had shoulder pain for quite a while now, but it got worse a few weeks ago. After resting my shoulder for a few days, I saw my doctor. He said that I had a chronic tear of my rotator cuff, judging from the symptoms I had and the ultrasound exam. He suggested that the best first step would be a good, aggressive physical therapy program, which will also help us understand better just what the problem is. At my age, surgery takes a bit more out of me than when I was younger, so it seems worth a try to see if I can avoid it." Dan, age 67 "Every time I move my shoulder a certain way, it's really painful. My range of motion has gotten better with physical therapy, but it still hurts a lot when I move it overhead. My doctor believes that the tendons are getting pinched in one area and that surgery may help relieve the pinching and pain. I know I'm going to be doing physical therapy for a long time still. But we agree that the surgery is reasonable to help that specific problem." Kwame, age What matters most to you? Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements. Reasons to have rotator cuff surgery Reasons not to have rotator cuff surgery I think surgery and physical therapy will help me regain the use of my shoulder faster. I don't mind waiting longer while I try rest and physical therapy to heal my shoulder.

7 More important Equally important More important The cost of surgery doesn't bother me. I'm worried about the costs of surgery. More important Equally important More important I can't do my daily activities because of my rotator cuff problems. I'm still able to do most of my daily activities even with my rotator cuff problems. More important Equally important More important The benefits of surgery outweigh the risks for me. I don't want to have surgery for any reason. More important Equally important More important My other important reasons: My other important reasons:

8 More important Equally important More important 4. Where are you leaning now? w that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now. Having surgery Leaning toward NOT having surgery Leaning toward Undecided Leaning toward 5. What else do you need to make your decision? Check the facts 1. If you have torn your rotator cuff in a sudden injury that is causing weakness in your shoulder, should you think about surgery? I'm not sure You're right. Surgery may be a good idea if you tore your rotator cuff in a sudden injury and the tear is making your shoulder weak. But surgery can't fully reverse problems that occur over time with wear and tear of the rotator cuff. 2. Can you limit rotator cuff damage by trying to treat it without surgery? I'm not sure You're right. You may be able to limit early rotator cuff damage with rest, ice and heat, medicines to relieve pain and swelling, and physical therapy. 3. Is surgery a good choice if you still have symptoms after 6 months of rest and physical therapy? I'm not sure

9 You're right. If you have symptoms that don't get better after 6 months of rest and physical therapy, surgery may help. Decide what's next 1. Do you understand the options available to you? 2. Are you clear about which benefits and side effects matter most to you? 3. Do you have enough support and advice from others to make a choice? Certainty 1. How sure do you feel right now about your decision? t sure at all Somewhat sure Very sure 2. Check what you need to do before you make this decision. I'm ready to take action. I want to discuss the options with others. I want to learn more about my options. 3. Use the following space to list questions, concerns, and next steps. Credits Credits

10 By Healthwise Staff Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP - Emergency Medicine Specialist Medical Reviewer Timothy Bhattacharyya, MD Appendix Topic Images Figure Shoulder The shoulder is made up of three bones: the scapula (shoulder blade), the humerus (upper arm bone), and the clavicle (collarbone). Muscles, tendons, and ligaments hold it together. The outer end of the collarbone is connected to the end (acromion) of the shoulder blade. The bursa is a fluid-filled sac that cushions and lubricates the shoulder area. The rotator cuff is the group of tendons and their related muscles that help keep the upper arm bone seated in the socket of the shoulder blade. Figure Torn Rotator Cuff

Illustration copyright 2000 by Nucleus Communications, Inc. All rights reserved. http://www.nucleusinc.

11 Illustration copyright 2000 by Nucleus Communications, Inc. All rights reserved. The rotator cuff is the group of tendons and related muscles that help keep the upper arm bone seated in the socket of the shoulder blade. A torn rotator cuff tendon can cause pain, weakness, and limited range of motion in the shoulder. A rotator cuff tear may be: Partial, in which only part of the fibers of the tendon are torn. Complete or full thickness, in which the tendon is torn all the way through. te: The "printer friendly" document will not contain all the information available in the online document. Some information (e.g. crossreferences to other topics, definitions or medical illustrations) is only available in the online version Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information.

Hammer, Claw, or Mallet Toe: Should I Have Surgery?

To print: Use your web browser's print feature. Close this window after printing. Hammer, Claw, or Mallet Toe: Should I Have Surgery? Here's a record of your answers. You can use it to talk with your doctor