What is Rotator Cuff Disease?
Cyrus Lashgari, MD
Rotator cuff disease is one of the most prevalent musculoskeletal disorders treated by orthopedic surgeons. Patients complain of pain over their shoulder that radiates to the elbow. The pain is often worse at night and can wake patients from sleep. Lifting the arm up or back exacerbates the pain. Knowing how your rotator cuff disease developed is critical when deciding treatment with your doctor. There are two major theories about why rotator cuff disease develops:
Wear and Tear. The tendons get impinged or pinched against the top bone in the shoulder as the arm is raised overhead. Repeated lifting can lead to a gradual tearing of the tendon over time.
Degeneration. The tendons degenerate over time and with age. Studies show that as we age, blood flow naturally decreases, limiting the tendons ability to heal. Most people with rotator cuff disease over the age of 70 have minimal to no symptoms or pain.
The rotator cuff does not have the ability to heal once torn. If left untreated, the tear often enlarges and the muscles tend to atrophy, or shrink. The injured muscle will also degrade, turning into fatty tissue. These changes will not improve even after surgery. Knowing this, many patients often conclude that surgery is the best option. Some cases should be fixed right away, but often nonoperative treatment should be tried first.
Rotator cuff tears tend to be more symptomatic in younger patients and those with recent injuries. These cases are treated more aggressively because of the risk of tear progression and muscle degeneration. Doctors will often choose to fix tears early before these changes occur.
If nonoperative treatment is chosen, yearly surveillance of the rotator cuff tear with MRI is often recommended to avoid the problems of tear enlargement and muscle degeneration.
Patients should discuss the risks and benefits of both operative and nonoperative management. When making treatment decisions, consider the size of the tear, the quality of the muscle, and the age of the patient. With this information, patients can decide their best option.
Cyrus Lashgari, MD, is an orthopedic surgeon with Anne Arundel Medical Group Orthopedic and Sports Medicine Specialists where he treats patients with conditions affecting the shoulder and elbow. He can be reached at 410.280.4708. For more information, visit www.osmc.net
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