Transcription:
A Closer Look at a Rotator Cuff Injury

Vicki Lewis: Welcome to Discussions With The Doc. This is a healthcare podcast brought to you by Coffee Regional Medical Center in Douglas, Georgia, where our mission is to provide exceptional care and wellness close to home. Join us as we learn more about rural healthcare in South Georgia.

Caitlin Whyte: Welcome back to another episode of Discussions With The Doc. I'm your host, Caitlin Whyte. And today, we are taking a closer look at a rotator cuff injury. We are joined for this conversation by Dr. Steve Augustine. He is a board-certified and fellowship-trained orthopedic surgeon with orthopedic surgeons of Georgia at Coffee Regional Medical Center.

So, Dr. Augustine, today, we are talking about rotator cuff injuries, a condition that for someone with your specialty sees quite a lot of. Why don't we start with some of the basics? Where is the rotator cuff and how does it become injured?

Steve Augustine, D.O.: Well, the rotator cuff is part of the shoulder itself. There's four muscles that make up the rotator cuff. So those muscles kind of combine and come together to kind of form like a real tenacious or almost like a leather belt type of tissues that attaches to the top of your humerus, which is the long bone in your upper arm. And so those muscles, when they contract, that tendon, that rotator cuff attaches to that bone, and that's what lifts your arm and move your arm around.

Caitlin Whyte: So if I do injure my rotator cuff, what kinds of symptoms would I notice that something's wrong up there?

Steve Augustine, D.O.: Well, there's kind of two injury classifications or two groups that I see typically. There's the older person or somebody that's a heavy laborer. Those people typically injure their rotator cuff from overuse from years of wear and tear, what we call attrition. And those are people that it just kind of comes on over the years.

And then, there's also what we call like the acute injury. So that's somebody that falls and tries to grab on to something or an athlete that takes a hard hit or somebody that lifts something very heavy and they'd get what we call like an acute tear of the rotator cuff where it kind of rips apart. Whereas in the one that's an overuse injury, it's kind of like the carpet where you walk in the room and it starts to thin and fray out, and it's kind of something that occurs over time and then you end up with a rotator cuff tear. So there's like what we call a traumatic tear, which is like an acute injury, heavy lifting, a fall, something like that. And then there's kind of this age-related or overuse type attrition tear that occurs.

And as far as the symptoms you might experience with those, you know, it's pain. Typically, people with rotator cuff tears, those ones that occur over time, those people will start to have pain, pain at night. You start to develop weakness in your shoulder. Those people that suffer those acute tears, those typically are people that, you know, have the injury, have significant pain in their shoulder, and then immediately lose strength even to the point where they're unable to lift their arm.

Caitlin Whyte: So let's talk about treatment. What does treatment look like for a rotator cuff injury?

Steve Augustine, D.O.: Well, I always tell patients that, you know, not every rotator cuff injury or a tear require surgery. So in those older people that, you know, start to get those wear and tear, those attritional tears, sometimes they still have pretty good function and sometimes it's something they can still live with. And even though we can pick up that tear on an MRI, It doesn't necessarily mean that that needs to have surgery or needs to be repaired.

The younger patient, the acute injury patient, those are the ones where I say, "You know what? You have full function of your shoulder. You had a good, robust, healthy rotator cuff tissue. This is the one we need to repair." and we like to repair those right away. So those other tears, I tell people, if you get to the point where injections don't work, physical therapy doesn't work, anti-inflammatories doesn't work. Then, you know, you need to think about having surgery and try and repair that. And again, it depends on how big those tears become. Some tears get so big over the years before people actually seek treatment, that those tears are what we call irrepairable. And in that case, sometimes we switch over to kind of this new technology, this new procedure, we do call it a reverse shoulder arthroplasty. And what that does is that replaces the shoulder. It creates a new mechanics to the shoulder and people are able to go from, you know, being very weak and painful to being able to lift their arm.

But, you know, there are some tears that are repairable. But the ones that have occurred over years, that if it's one that's kind of been put off and neglected, or maybe people that have had two or three surgeries, and it's just irrepairable, sometimes we do that reverse shoulder arthroplasty procedure. But the young ones, you fix those. The acute tears, the ones that happen from injuries, those do well. You get, you know, repaired and tied back down to the bone they do well.

And then there's kind of, like I said, that that gray zone where you get these people that have tears, sometimes they bother them, sometimes they don't. But when they get to the point where conservative measures have not worked, then we talk about the repair. And again, there's a lot of predictive things that we look at to see whether or not even doing the surgery is worthwhile. And that's like, how far has the tear retracted back? How many tendons of the rotator cuff are involved? How much atrophy has the muscle sustained over the years? And does it have what we call fatty infiltration? Which means that just the muscle, even though it's there, is not very functional. And so doing a repair, you know, if you have a muscle that's not going to really work, then it's sometimes not worth it. So there's a lot of different factors that come into play in terms of decision-making for rotator cuff, whether or not you do the surgery or what type of surgery actually do.

Caitlin Whyte: Okay. I'd love to touch on those injuries you talked about where they get put off. Can you explain the importance of getting something like this looked at pretty soon after the injury? I mean, what could happen if you do put it off?

Steve Augustine, D.O.: Well, if it's an acute tear, in other words, one from a fall or one from, you know, falling from a height and grabbing onto something or one from a sports injury, something like that, those are the ones you want to get to right away, because they're usually younger, healthy people that, you know, have had a completely normal shoulder, now they don't. And you don't want to put that off because the longer you put things off, the more that tendon becomes retracted, the less likely it's a good healing environment for that tendon, the muscles start to atrophy. And what I mean by that is you really like to get to that repair, that surgery within four to six weeks. The sooner, the better. But you know, kind of that six-week window, you don't want to wait past that. So say somebody has a Workers' Comp injury and they're kind of getting lost in the shuffle, those are people that kind of need to be pushed to be seen earlier when they think they have a rotator cuff tear. Get that MRI done right away. Athletes are typically ones that they know what's wrong with their body, so they're going to get that done right away. The longer you wait, again, the more difficult the surgery becomes, the less likely that good healing and outcome is going to occur.

Caitlin Whyte: Well, let's talk about recovery. How long does it take to kind of get back to what we might call "normal," if that's even an option after this injury. And thinking about, you know, those athletes, can you go back to your old lifestyle after an injury like this?

Steve Augustine, D.O.: And again, not to classify people as an athlete or a non-athlete, you know, I still think that there are people out there that are as functional as athletes in terms of their jobs, their careers, whatever they do, you know, heavy laborers, that sort of thing. But the younger person that gets a repair for an acute injury, you know, because they have good quality tissue, they're motivated, they typically will get back to their lifestyle again. Not everybody does, but if things go well, they go through the rehab program. And what I mean by that for say an acute injury, one that occurs from a traumatic injury, those people have surgery, they're typically in a sling for about four weeks, their rehab program, their therapy is about another two to three months. And they may be back to their activities within, you know, four to six months in terms of full activities.

Now, if it's a throwing athlete or overhead athlete, that may take a little more time. As far as, you know, when we're looking at, you know, wear and tear attritional tears, the ones that occur with age, the wearing out of the rotator cuff tissue, those typically, you know, do not heal as well. There's a lot of factors that go into that, whether somebody is a smoker and, again, all of those other factors that I talked about as far as what's the rotator cuff tissue like, how big is the tear, how far it's retracted. And then again, I mentioned like co-morbidities, like is the patient a smoker? Does the patient have diabetes? Are there other things that are going to keep it from healing as well? And then the age, obviously things as we get older don't heal as well as when we're in our 20s as an athlete or as a heavy laborer. So those people typically will get back to activity levels. I don't think they do as well as those young people that have those acute tears. In other words, they may not get as much motion back. They may not get as much strength back. But fortunately, the majority of people get pain relief. And that's really one of the benefits of doing the surgery.

Caitlin Whyte: Well, doctor, Coffee Regional was recently accredited as an Orthopedic Center of Excellence, which is--

Steve Augustine, D.O.: Exciting.

Caitlin Whyte: Yes, absolutely. It's just such a testament to the dedication and compassion that you have for your patients. Can you tell us about how this accreditation benefits patients coming to you for this orthopedic care?

Steve Augustine, D.O.: Yeah, absolutely. So that's something we're really proud of. It's a collaboration of a lot of the different departments in the hospital. And what that Center of Excellence is, is a third party evaluator that comes in and looks at the hospital and looks at orthopedic programs like our joint replacement, total knee, total hip replacements, our shoulder replacement and our spine surgery and they hold you to a certain standard. So this third party comes in and evaluates, and then they basically give you an accreditation based on your scores through multiple categories.

And like I said, it's a collaboration of the whole hospital coming together to provide the patient with the best experience and the best outcomes that we can in regards to those types of surgeries. And so, you know, the anesthesia department, the physical therapy department, the nursing department, the dietary department, we all come together to optimize that patient's outcome. And basically, that Center of Excellence designation basically says that we're held to a certain standard and we're providing that level of care.

Caitlin Whyte: Well, doctor, as we wrap up our interview today, is there anything else that you'd like patients to know about the rotator cuff and injuries they could sustain?

Steve Augustine, D.O.: Yeah, I think that it's one of those things that's very common. I think that if you are having shoulder pain or you develop weakness, if you have night pain in your shoulder, then I would definitely recommend that you get it evaluated. Find out if in fact it's your rotator cuff or it may be something else. Like I said, not every patient has to have surgery when it's a rotator cuff problem. So don't be afraid that if you come to the office, that you're going to be told you have to have surgery. So there are other things that we can do to try and help you by.

Caitlin Whyte: Well, thank you, Dr. Augustine, for taking the time to walk us through the symptoms and treatment options of rotator cuff injuries. Dr. Augustine sees patients throughout South Georgia, including Douglas, Hazlehurst, Tifton and Homerville. To schedule an appointment with Dr. Augustine, please call 912-383-6575 or visit our website at orthopedicsurgeonsofga.com.

Vicki Lewis: We've decided to create this podcast, to educate our community and enlighten those throughout our great nation about rural healthcare. We hope you subscribe and enjoy Discussions With The Doc. Thank you for listening to this podcast sponsored by Coffee Regional Medical Center, where our purpose is to serve, to heal, to save.

Caitlin Whyte: This concludes today's episode of Discussions With The Doc. We invite you to download, subscribe, rate, and review our podcast on Apple Podcast, Google Podcast, and Spotify. For more episodes and information on our providers and services, visit us online at coffeeregional.org. This program aims to enhance your health and wellness knowledge by fulfilling the vision of Coffee Regional Medical Center: healthy lifestyles, better lives.

None of the information provided in this episode should serve as a diagnosis or approval of the treatment for any ailment. The information and opinions provided in the podcast do not create any type of doctor-patient relationship. By listening to this podcast, you agree not to use this podcast as medical advice to treat any medical condition in either yourself or others, including but not limited to patients that you are treating. Consult your own physician for any medical issues that you may be having.

The opinions of the guests do not necessarily represent the opinion of Coffee Regional Medical Center.