Q&A: Treating shoulder pain and rotator cuff tears

By Andrew Rocca, M.D.

Q&A: Treating shoulder pain and rotator cuff tears
By Andrew Rocca, M.D.


 

When should I see an orthopedic specialist?

I recommend scheduling an appointment with an orthopedic specialist after experiencing unexplained shoulder pain for more than a week. You also should see a specialist if you experienced an injury and know something is wrong.

Sudden shoulder weakness should be looked at sooner rather than later so we can start the right treatment as quickly as possible. After a tear occurs, there is an optimal time period in which we can treat the tear most effectively.

What should I expect during my appointment?

We’re looking to make a diagnosis and develop a treatment plan. It’s important to realize that treatment is not always surgical, and that surgery is less common than nonsurgical treatment for many shoulder injuries. After examining the shoulder, we order x-rays and then determine what should be done next.

What are the treatment options?

We usually start the process with conservative management such as physical therapy and medications. Very rarely do we see someone and immediately recommend surgery.

Imaging studies can help us identify the problem and choose a course of treatment. If a condition is not evident on x-rays, then an MRI may be the next step, because we want to see if there was soft tissue damage and check for a rotator cuff tear. From there, we review the results and discuss treatment options.

Treatment includes both surgical and nonsurgical options, such as activity modification, anti-inflammatories, steroid injections and physical therapy. But if someone comes in with a rotator cuff tear, surgery is the only way to actually repair it.

When considering whether surgery makes sense, we look at activity level and underlying medical conditions, as well as other issues that may complicate a patient’s ability to heal.

What is the surgical recovery process like?

The recovery process consists of three general phases.

In phase one, we let the initial repair heal. In phase two, we’re trying to mobilize the joint; I call it the stretching phase. Phase three is a strengthening phase. Each of these phases lasts roughly six weeks, i.e., six weeks in a sling, six weeks of stretching and six weeks of strengthening.

How do you perform the surgery?

Rotator cuff repairs typically are done arthroscopically, so a big part of my practice is fixing shoulders and using arthroscopic techniques to repair rotator cuffs.

What is arthroscopic surgery, and what are its advantages?

Arthroscopy is a surgical procedure used to visualize, diagnose and treat problems inside of a joint. Arthroscopic techniques help us see better, and the tools we use during arthroscopic surgeries fit through tiny incisions.

While MRIs are the best non-invasive diagnostic tool, arthroscopy is an even better diagnostic tool, because we’re able to see, touch and mobilize tissues to confirm diagnoses. Or we can use it to identify and treat other conditions.

There are times we may plan to repair a patient’s rotator cuff, but we also find out that they have other tears. By performing an arthroscopic procedure, we’re able to repair both tears during the same operation.

How has rotator cuff surgery changed over the years?

There’s been a lot of advancement in the video technology and instrumentation used in rotator cuff operations. For example, anchors, the equipment used to fix a rotator cuff tear, have changed significantly. While anchors used to be largely made from metal, most anchors are now made with a material that dissolves and actually turns into bone after a couple of years. This means newer anchors hold the rotator cuff in place while it’s healing, before turning into bone when they are no longer needed.

Suture technology also has advanced. When we repair rotator cuff tendons and sew them back down, we use sutures to fixate the tendons to the anchors. The newest sutures, that I use, actually get tighter on the rotator cuff and hold better over time rather than loosening.

What should I consider when choosing an orthopedic specialist?

It’s important to find a surgeon who performs rotator cuff repairs regularly. Specialty training is important, but the frequency of doing these repairs is another key factor. It’s vital that you make sure rotator cuff repairs are a big part of the physician’s practice.

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