The rotator cuff is a group of muscles around the shoulder. They help with the shoulder function and the stability of the shoulder. Often, if you have a compromise or injury to the shoulder, it can inhibit your function of that shoulder.
There are two main reasons for a rotator cuff to tear. One can be traumatic, and that could be from a bad ski accident, falling off your bike, or being a weekend warrior where you take a spill and that rotator cuff can obviously get torn. The other possibility is that over time it can degenerate. As we get older, we’re more at risk for the tendon quality and integrity to change. If it does, then we’re more susceptible to a rotator cuff tear over time as we get older.
Often pain is what brings patients into the office. Pain and then usually loss of function or strength. Over time, that usually does progress and often does require further workup at that point for the rotator cuff injury.
Typically as you get older, you’re at higher risk for rotator cuff injuries. It can happen to young people and that’s usually more traumatic in nature. But as we get older, we’re a little bit more susceptible to rotator cuff injuries over time.
It can be cumulative injury over time. The tendon quality and integrity over time can be compromised. As we get older, the tendon itself is not quite what it was when we were younger and that puts us at risk at that point.
We hear from the patient how long they have been having pain and what has been causing them pain. There are certain maneuvers that we can use in the office that really give us a good understanding of the rotator cuff injury that we’re suspicious about.
Imaging, typically either an MRI or ultrasound, is usually how we confirm that a rotator cuff injury has occurred.
It can. But in terms of how we repair rotator cuffs, surgery has come a long way. We can do more minimally invasive procedures where patients do not have the same kind of pain afterwards, and recovery can definitely be expedited after the surgery to get you back to that normal function.
We have a new tool, a device known as a subacromial balloon spacer. It has only been FDA-approved here in the United States for the last six months or so. This is for a specific type of patient, where they have an irreparable or massive rotator cuff tear, one where we’re really concerned about re-tearing over time.
This device is essentially a balloon that fills up the space where the rotator cuff is deficient, and that can provide better support and stability and usually better pain relief over time.
Patients anecdotally feel much better much quicker. Typically by about six weeks, patients are feeling pretty close to where most of that pain relief has occurred. Their function continues to improve over the first three months.
You don’t have to stay in the hospital at all. You can go home the same day. Typically, patients are pretty comfortable. Pain medications are really something that we try to minimize after this surgery. Thankfully we have not seen that patients need much of that afterwards.
This balloon is a device that will eventually dissolve in approximately one year. But at least based on the European data and the data that we have from almost 29,000 patients, patients can have up to five years if not longer relief with this type of device. The expectation or theory behind that is eventually that the shoulder will stabilize in a new position and the muscles will recouple into a new position where you can still have pain relief even after this balloon dissolves.
Inside this balloon is saline, so the risk of it is very, very low too, complications very low.
This is something where you need to see an orthopedic surgeon to be fully evaluated for this.
Having the imaging and history that correlate with a massive rotator cuff tear can make you a candidate for this type of device.
The device will be inserted into the shoulder where it will help alleviate the pain that is associated with a massive rotator tear.
To some extent, it’s a little bit of a catch-22. Most active people to some extent can be at risk, especially for a traumatic injury of the rotator cuff. There are other risk factors too. Smoking is a big one. Certain other factors, such as high cholesterol, can also be a risk factor for tendon degeneration over time.
If you suspect you are having rotator cuff symptoms, it’s something you will want to get checked out right away.
If you’re having pain in the shoulder, and you feel that your function and even sleep are starting to become affected, it is possible that you may have a rotator cuff injury. If this has been sustained or it seems to be progressive in nature, then it’s definitely time to see an orthopedic surgeon to have that evaluated.
I’m very happy to be able to share with patients some of the new tools and treatments that we have for patients with rotator cuff injuries. There are a lot of new devices and a lot of new treatments that really make a big difference for patients to get back to the things that they love in spite of having a rotator cuff injury.
Lightly edited for clarity.
Watch the San Diego Health video with host Susan Taylor and Dr. Rebolledo discussing treatments for torn rotator cuffs.