Prakash Chandran (Host): Welcome to BayCare HealthChat. I'm Prakash Chandran, and in this episode we're going to be talking about torn rotator cuffs, their symptoms, causes, and treatments. Joining us today is Dr. Nick Sexton, an orthopedic surgeon at BayCare Health System. Dr. Sexton, thank you so much for joining us today. I really appreciate your time.

Now, before we get into rotator cuff tears, I just wanted to get started with the basics. What exactly is the rotator cuff?

Nick Sexton, MD: The rotator cuff is a collection of muscles. There's four of them, and they're in the shoulder and they kind of converge and coalesce into one cuff of tissue, which is why it's called the rotator cuff, and can be a source of pain and weakness.

Host: Okay, so tell us then what happens when that rotator cuff tears? Like what exactly does that mean?

Nick Sexton, MD: Well, there's two basic mechanisms. One of them can be a simple traumatic tear, so you lift something heavy too quickly or try to catch something heavy that falls and you can get a traumatic tear. That's the most basic concept, but also it can be a wear and tear issue. So the rotator cuff, it's a spectrum of disease where it can start off as inflammation, and then the tendon quality kind of degrades and turns into tendinosis, and then maybe a year later you get a partial tear and then it evolves into a full tear. So it can be a lengthy, chronic process at times.

Host: Okay, so what I'm hearing is that it could be caused by something that happens more acutely or it could happen over time, that general wear and tear that you were mentioning. Is that correct?

Nick Sexton, MD: Right. Or you could have a weakened tendon and then it doesn't take as much of a sudden acute event to cause that full tear.

Host: Okay, so what are some of the symptoms that people experience when they either have a torn rotator cuff or they're, I guess, at risk for getting a tear?

Nick Sexton, MD: Right. Some of the key symptoms are pain, obviously, but more specifically like when you're lifting your arm up over your head, you're going to get some pain in your shoulder in the front and the side of your shoulder. Weakness, you know, you can have weakness when trying to lift. One of the hallmark symptoms is pain at nighttime. We call that nocturnal pain. So pain when you're trying to rest and sleep at night, especially if you're rolling over and laying on that affected shoulder. And then occasionally you can get some little cracking or popping in the shoulder with certain positions.

Host: Okay. And so, tell me a little bit about like when people start to experience it or when they have a torn rotator cuff, when do they know that it is something severe that they should come in for? And what is that process like of treatment?

Nick Sexton, MD: Sometimes just with any kind of ache or pain, you know, I recommend, try some anti-inflammatory medications and give it a week or two, or maybe three. But if there's something persistent, that's not getting better after a few weeks, that's when you're going to want to visit with a specialist, someone who specializes in rotator cuff problems.

And, then you can get guided down that sort of path of treatment.

Host: Okay. And one of the things I wanted to come back to is you mentioned like tendinosis, I've heard of tendonitis before. Can you, at a high level talk about what those two are and the differences between them?

Nick Sexton, MD: Yeah, that's a great distinction and something a lot of people aren't aware of. So tendonitis, is the fancy way of saying an inflamed tendon. So if it's purely inflamed, that means it's not really torn and therefore maybe some anti-inflammatory, like, ibuprofen or something might help.

Or a steroid injection, which can be done, with ultrasound guidance directly at the tendon can decrease the inflammation. And those are good treatments if it's not fully torn. And tendinosis, what tendinosis is, is actually when the tendon starts to degrade or degenerate and start to break down and become less healthy. So not only is it inflamed, it's becoming a less strong tendon, but it's not necessarily torn yet.

Host: That makes sense. And I guess taking a step back, I was curious about who rotator cuff tears affect the most, like what age group or demographic?

Nick Sexton, MD: Yeah, that's a good question. And so typically you're going to see this starting in maybe people in their fifties and on up. I've seen it in younger people, especially that traumatic version of the injury, but the more degenerative process, where people have the more chronic tears; you'll see that starting in the fifties and on up. There's people that are maybe in their eighties and nineties that have a tear and they're doing fine.

So sometimes people can cope with it. But when it causes pain and weakness and really prevents you from doing either, whether it's work or sports or day-to-day activities, that's when you got to do something about it.

Host: And you started to touch on this, but I want to talk a little bit more about treatment because there are so many different types of tears that we've talked about, is surgery the only treatment option here because it's an actual tear, or are there also nonsurgical options to consider?

Nick Sexton, MD: Yeah, there's definitely other options and this is my favorite aspect to talk about because it really depends on what's the status of it. I mean, if you're a, a person who's a working person, you're very active and it's fully torn, then I'm going to probably recommend surgery to treat it, to fix it, cause otherwise, you know, if it's fully torn, the tendon can't really heal that gap.

And so you're going to need some help with that. If it's a partial tear or you have the tendinosis, and it's not fully torn, then there's certainly other treatment options like physical therapy, perhaps even a home exercise physical therapy program, injections. And so steroid injections are classically have been done in the past, but they don't really cause the tendon to heal. They just get rid of that inflammation.

And then the other exciting thing is when we repair these over the last decade, they've been really hard to get to heal. But we have some techniques now of augmenting the repair with patches made out of different tissues, whether it's, cadaver human tissue versus even cow tissue in some cases to help augment and strengthen that repair.

Host: Yeah, I'd like to talk a little bit more about recovery time. Can you tell us, like traditionally how long recovery time has taken and now with these new augmented measures that you're discussing, how it has expedited the recovery process?

Nick Sexton, MD: Yeah, one of the big conundrums or downsides of rotator cuff repair is, is like, it is a long recovery compared to some other surgeries we do. And so you're typically in a sling for four to six weeks after surgery. The bigger and worse the tear is, maybe longer. And after that, you're not just done.

You then at that point, you know you're really going to be working on range of motion and strengthening. And so I tell people, depending on the tear and depending on the person, four to six months for full recovery, even up to a year.

Host: Now, is there such thing as people, potentially getting a tear and just living with it for a while so it never fully heals? So for example, their mobility may not be what it could be. Have you heard of this before?

Nick Sexton, MD: Absolutely. Yeah. I mean, there's certain people that, if they're too sick and surgery is too risky for them; maybe we'll just do injections and physical therapy and things like that, and it's possible they can live with it. But if you're a working person or an active person and a younger person maybe and you've got a full tear, if you don't get it fixed, it's going to continue to get larger and undergo a process in which that tendon degenerates even further to the point at which it'll not be repairable.

And if you allow that to happen, then you kind of burn your option of repair, and then at that point, the only real option is a shoulder replacement.

Host: Yeah. So I think the takeaway there is I think oftentimes, especially I guess maybe when you're a little bit younger, you're like, oh, I'll just deal with it. It's fine. But that actually isn't a good idea, right? Like, you want to make sure that it doesn't get worse over time and you limit the treatment options. So it's always best to go in to see a specialist like yourself.

Nick Sexton, MD: Yeah, you want to go in, get an exam, that's the primary thing you know, orthopedics. We're big on the physical exam and really checking out the shoulder. Oftentimes an MRI or an ultrasound to visualize, you know, x-rays is what we'll start with to see if there's any arthritis in that shoulder joint.

And then an MRI or an ultrasound exam are super effective at actually looking at the tendon to determine whether there's a partial tear or full tear, or maybe just tendinosis or tendonitis.

Host: Okay, that's really helpful. So, being an orthopedic surgeon, you've probably seen hundreds if not thousands of patients, especially with rotator cuff tears. What's one thing that you know to be true that you want our audience to take away from this conversation?

Nick Sexton, MD: Yeah, the biggest problem that I can't fix is if like we just talked about someone that has a tear and they neglect it. They have a high, maybe they have a high threshold for pain and they kind of neglect it. In fact, my dad is, a good example, so he neglected it and now his shoulders are the only treatment really is the shoulder replacement. And he's even putting that off cause he's very stoic. So yeah, go in, get checked out. It doesn't obligate you to do anything as far as treatment or surgery, but just get checked out, get an opinion, maybe get two opinions and find out what your options are.

Host: Well, I think that is a great place to end. Thank you so much for your time today, Dr. Sexton.

Nick Sexton, MD: Thanks. Appreciate it.

Host: That was Dr. Nick Sexton, an orthopedic surgeon at BayCare. And that wraps this episode of BayCare HealthChat. You can head on over to our website at BayCare.org for more information and to get connected with one of our providers.

Please remember to subscribe, rate, and review this podcast and all other BayCare podcasts, and for more health tips and updates, follow us on your social channels. Thanks again for listening. My name is Prakash Chandran. Be well.