Understanding When Surgery is Right – Rotator Cuff

Deciding how to care for shoulder injuries can be very tricky. For the shoulder joint to work properly, all of the muscles and tendons that hold it together and allow for fluid motion must be healthy and strong. If one of the muscles is inflamed or torn, it can cause joint pain, weakness, or loss of motion. But how do you know if surgical correction is the best solution for your particular shoulder injury?


Rotator Cuff Basics. The rotator cuff is the group of muscles and tendons that keeps the humerus (upper arm bone) positioned firmly inside the shoulder socket. These are the muscles that allow you to move your shoulder with full range of motion. When one of these muscles or tendons is compromised, it can cause pain, shoulder weakness, partial loss of motion, or in some cases total loss of motion. If your shoulder injury prohibits you from moving the joint in any way, I’d recommend have it checked as soon as possible.


While commonly called a rotator cuff tear, this type of injury isn’t always an actual tear in the tissue. When any of the four muscles that make up the rotator cuff are inflamed or weakened, it is still referred to as a rotator cuff tear. Often people complain of increased pain while sleeping, which can be the result of laying on the injured side or decreased oxygen in the bloodstream due to sleep apnea.


Risk Factors. This injury is commonly seen in people over fifty. Patients who regularly engage in overhead sports, work a job that requires heavy lifting or overhead movement (construction jobs, house painter, etc.), and smokers are all at a higher risk of developing a rotator cuff tear.


With my patients, I have found that those with rotator cuff tears often have one or more of the following comorbidities: carpal tunnel syndrome, cubital tunnel syndrome, TMD, posterior rib subluxation, back pain (with or without associated obstructed breathing), and pelvic tilting. Since these conditions affect the shoulder, I take them into account when deciding on how to treat an injury.


Treatment. In my opinion, many orthopaedic specialists are too quick to recommend surgery with the end goal of relieving shoulder pain. Before I perform surgery on my patients, I give them a treatment plan that includes conservative care methods (including physical therapy and corticosteroid injections), as well as the treatment of all comorbidities that could be affecting the shoulder joint.


If the patient has followed the conservative treatment plan without any relief or improvement, then I will recommend surgical correction. I’m quicker to perform rotator cuff operations on patients who have high-demand jobs that involve heavy lifting or overhead work and on patients who cannot perform their daily routines.


The takeaway is this: every shoulder injury is different, and every orthopaedic specialist will likely have a different approach to treatment. Listen to your doctor and your body, and give conservative treatment methods a chance before deciding to have surgery.