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Rotator Cuff Problems
Even though every rotator cuff problem is unique, if you have shoulder pain related to your rotator cuff you likely fall into one of two groups:
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If you have had a shoulder injury that makes it impossible to raise your arm above your head and if the pain is bad enough to wake you up at night, you should be seen right away for an evaluation.
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If you have not had an injury and you are having pain in your upper arm but you are able to fully move your arm in all directions, the pain could be coming from the rotator cuff or the bursa, which is the space around the rotator cuff.
You Set the Goals for Treatment
Regardless of whether your rotator cuff injury is as a result of an injury or just living life, the symptoms could include pain that affects your daily activities, weakness with overhead use of your arm, and difficulty sleeping at night. It is important for me to understand which one of these symptoms you have, and which ones you absolutely need addressed. For example, some people are happy if they are just able to sleep at night, and they are able to tolerate having some pain during the day and do not necessarily need to be able to lift anything heavy over their head. Other patients rely on their shoulder for their livelihood and need it to be as normal as possible, even if that means that they will need to have a surgery with a 6 to 12 month recovery. By listening to what is important to you, I am able to give you the treatment options that are likely to get you where you need to go.
We Discuss Treatment Options
The goal of our treatment plan is to get you the best possible long term result, while minimizing your exposure to risk. This is why for people who have not had a recent injury, I often recommend first trying conservative management with a course of NSAIDs and a few visits with a physical therapist to learn some home exercises. Many people will see some improvement after 6-12 weeks of home exercises, and then it will be up to you to tell me if the shoulder is good enough. Surgery is always a last resort for all of my patients, but it may be a good option you do not improve with the home exercises or if you are an active person with a new injury and a complete tear of a rotator cuff tendon like in this picture.
Frequently Asked Questions
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How do we know we are making the right decision? We are always making decisions with imperfect information, so we have to do our best to make the best possible decision based on your values and my experience. Once we make a decision, we move forward together with confidence that we made the best possible decision with the information we had.
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Will my rotator cuff surgery be successful? There are two things that have to be true for us to go ahead with rotator cuff repair: 1) the patient needs to tell me that their shoulder is bad enough to want to have surgery, and 2) I need to tell the patient what I think the chances are that their shoulder will get better with surgery. We are in the process of looking back at our results over the last few years to see if people say they are glad they did the surgery, and to see how much they improved by comparing what percent of normal they rated their shoulder before an after surgery. So far it looks like more than 95% of people are glad they did the surgery and the average change is more than 50 percentage points, meaning that someone whose shoulder started out at 30% of normal can end up with a shoulder that feels better than 80% of normal.
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What is the best way to ensure a good surgical result? In addition to doing the surgery with the latest techniques, it is important that the patient also does their part by getting their diabetes under control, quitting smoking, and preparing for the long recovery. Surgery is a partnership where everyone has to do their part, and if the patient, surgeon, and physical therapist are on the same page, it is possible to get the best possible result even for the most difficult cases. Click here to get an idea of how to prepare for your rotator cuff surgery and see the instructions you will be given on the day of surgery.