Dr. Kaminsky is a Shoulder Specialist with Premier Orthopedics & Sports Medicine. He also offers instructional courses to other orthopedic surgeons on advanced minimally invasive rotator cuff repair and shoulder reconstruction. 

Dr. Kaminsky answers questions about Rotator Cuff Tears:

What is the rotator cuff?
 

The rotator cuff is a series of four deep muscles around the shoulder that converge together, forming a “cuff” of tissue. The four muscles are the supraspinatus, infraspinatus, subscapularis, and teres minor. The tendons of these muscles are attached to the ball of the shoulder and envelope the shoulder joint.

What does the rotator cuff do?

The rotator cuff provides power and strength of the shoulder, particularly with the arm in an outstretched or overhead position. The rotator cuff is important not only for sports, but also for day-to-day activities and work duties.

What happens if I tear my rotator cuff?

When there is a tear of the rotator cuff, the tendon usually detaches from the humerus (ball of the shoulder). When this occurs, the tendon typically cannot re-attach itself to the shoulder. There is also concern that the tendon tear can get larger over time.

 Torn rotator cuff tendon on the left with the top of the ball of the 
 humerus exposed on the right.

What are symptoms of a rotator cuff tear?

Pain is a common complaint with a rotator cuff tear. Pain at night is typically present, and it can be difficult to lie on the injured shoulder, find a comfortable sleeping position, or get a good night’s sleep. Weakness is also typical, especially reaching for heavier objects away from the body, out to one’s side, or behind you. 

How do I know if my rotator cuff is torn?

In addition to noting your symptoms and obtaining x-rays, your doctor will perform an examination that will evaluate the motion and strength of your shoulder and perform some specific tests. A magnetic resonance imaging study (MRI) is a common test your doctor may order to look for a torn rotator cuff. X-rays evaluate the bones of the shoulder, but the MRI reveals the soft-tissue inside such as the ligaments, cartilage, and rotator cuff.

What is the recommended treatment?

In general, for healthy and active individuals, repair of the torn tendons is recommended. Once symptoms begin after a tear occurs, the symptoms usually persist until a surgical repair is undertaken. Your doctor can discuss with you the specifics of your type of tear and the recommended treatment.

How does a rotator cuff tear happen?

While some rotator cuff tears occur during a sports event, many rotator cuff tears occur without any obvious injury. Rotator cuff tears can arise from less strenuous injuries such as a fall, lifting something, or reaching or pulling in an awkward arm position. Pain may start immediately or become more apparent later. 

How is the surgery performed?

Repair of the rotator cuff is an outpatient procedure that typically takes approximately one hour to complete. The torn tendons are re-attached to the shoulder using specially designed screws and sutures placed in a specific pattern. The surgery can be performed through an incision (open rotator cuff repair) or through small holes with the use of a scope (arthroscopic rotator cuff repair). 

 Completed rotator cuff repair.

How long is the recovery?

Several months of recovery time is typically necessary to allow the tendon to more fully heal back to the bone. While light activity and use of the arm is allowed during this period, heavier and repetitive activities should be avoided. Physical therapy is used during this time, and activities are gradually increased as healing progresses.

What are questions to ask my doctor?

Repair of the rotator cuff is a technical procedure and should be performed by someone who performs this surgery routinely. Ask your doctor how many of these surgeries he or she performs, how long the procedure takes for that physician to complete the surgery, how often the procedure is performed arthroscopically or through an incision, and typical outcomes. Get a second opinion if you want to compare the information you receive. 

Is the surgery successful?

Repair of the torn rotator cuff typically allows our patients to return to their pre-injury level of activity without pain. Pain relief, the ability to sleep comfortably, and improved strength are typical improvements voiced by our patients. Speak with your doctor to discuss your individual expectations following surgery.