Hi, I’m Dr. Chris O’Grady. I wanted to talk to you today about rotator cuff tears, particularly the treatment of rotator cuff tears. So diagnosing a rotator cuff tear can be a bit challenging. There’s certainly very many hallmark-type symptoms. Sometimes there’s a preceding injury, sometimes there’s not. There’s a lot on my website about these symptoms and things that you can look for, and you’re obviously welcome to go and research that.
But in terms of treating a rotator cuff tear, once you’ve been told that you have one, there are some things you should know. First off, not all rotator cuff tears need surgery. There’s a natural process that occurs in all people, active or inactive, just like people who get gray hairs you get into your 60s, 70s. It’s pretty normal to have some partial tearing of your rotator cuff. And so an MRI that says you have a rotator cuff tear does not mean that you need surgery. I would say the vast majority of people that I see who have rotator cuff tears are treated successfully with a combination of anti-inflammatories, injections, and most importantly physical therapy.
There are two major categories of operative rotator cuff tears. Those that are injuries and are acute, and those that are chronic. And so injuries are obvious, and that can be anyone from a young athletic player on a field who has a bad tackle or something where they feel the pop in their shoulder. Those thankfully are rare, but they become more common as we age and can occur in less dramatic ways. It can be something as simple as picking up something heavy and you feel a tear.
There are also a large number of rotator cuff tears that simply are chronic. They are nags and aches in the shoulder that aren’t necessarily pins to one point in time when it started hurting, but the pain just continues to get worse, feels like that toothache in the arm.
And may find out right off the bat with this examination or MRI that it’s a really large rotator cuff tear, and it can be very frustrating that this may be a process that’s been going on for a long time before you finally had someone get an MRI and do a good examination to diagnose that.
Either way, if you have a full thickness rotator cuff tear, generally it’s going to need to be fixed. So the gold standard to repair rotator cuff is to do it all arthroscopically, and that means through very small incisions in and around your shoulder. There’s usually three or four, sometimes maybe even five depending on the size of the tear, but they all are so small that they require just one suture. That allows the surgeon to get in there, take a look around, and determine if there’s any other pathology that needs to be addressed, but also to do all of the repairing of the rotator cuff to bring that tendon back down to the bone.
Surgery generally takes about an hour plus or minus. In our facility, you’ll have what’s called a regional block. It will entirely numb your shoulder for the surgery. You will be asleep during the surgery, but you keep that block for several days after surgery, which really minimizes your need for any narcotic pain, and in many cases completely eliminates the surgical pain.
The surgery itself is pretty straightforward. Once it’s repaired, you go home. You start therapy within a couple of days. The thing to understand is that the recovery is lengthy, and although there’s lots of research going on looking at ways to speed up the process of healing, general rule of thumb is that it’s going to take somewhere around six months for you to fully recovery for a rotator cuff repair. That may be a bit shorter for small tears. It can be longer for larger tears.
But generally we’re looking about six months total. The first four to six weeks of that is in a sling. That’s why I always tell patients you’ve go to be prepared to do the therapy, and to commit to being a good patient, which means staying in the sling and only doing what you’re told to do in therapy without trying to overdo it or be a hero because you can undo all the good the surgeon did in the surgery, and then you’re actually worse off than when you started.
So in review, most rotator cuff tears do not require surgery. Those that do are generally done all arthroscopically. With a good set of anesthesiologists on the surgical team, you’ll have a block, and that block really will minimize your discomfort for the surgery and for days afterwards. Surgery itself takes about an hour plus or minus depending on the size of the tear, and perhaps most importantly you’ve got to be ready to commit to the post-operative physical therapy and the limitations that you’ll have for several months after surgery.
You put all that together, and the expectation is that you will have a shoulder which works normally or near normally, and shouldn’t bother you nearly as much as it did pre-operatively, and in most cases doesn’t bother you at all.
If you want more information about rotator cuff tears, again you’re welcome to look at my website and read some of the blogs that we have on that. Thanks for watching.
Hi there, I’m Chris O’Grady. I wanted to talk to you today briefly about distal biceps ruptures. A distal biceps rupture is not a subtle thing. When it happens to you, you know it. It generally happens when somebody… Usually somebody 35 or older carrying something heavy, and all of a sudden there’s a pop in your elbow. A lot of people will even say they can feel the tendon just kind of retract. It’s very painful. It generally turns black and blue almost immediately. Then it kind of stops hurting. The important thing to understand is that there are other muscles that flex your elbow. You don’t lose the ability to flex your elbow, it may be somewhat confusing trying to figure out why you can still do that if there’s no biceps tendon attached. Your biceps muscle primarily both flexes and also what we call supinates the forearm. It’s very important functionally for things that we do with our hands and wrists.
If you don’t have a distal biceps you’re going to lose about 50% of your ability to do that, and upwards of 40% of your ability to flex your elbow. For a young, active, healthy person that’s unacceptable. It’s very easily attached surgically. It’s something that has a very high success rate. Once it’s healed you have very little recurrence rate of it popping again. But what’s important to understand is that it’s really a very straightforward process, if you can get to this injury early. And by early, I mean within a week or two. Once you get outside three or four weeks from this injury, it starts to scar in to the vessels and nerves in the elbow, and it can get a little bit more dicey in terms of the surgical risk. If you think you have this injury, I would not delay a trip to the orthopedic surgeon, or at least a sports medicine doctor, who can take a look and give you the correct diagnosis. If it is in fact ruptured, I’d again encourage you to seek the treatment from a orthopedic surgeon as soon as you can. Thank you very much.