Scott Webb (Host): A healthy rotator cuff in our shoulders is essential to normal and pain-free use of our shoulders and arms. And in this episode, Dr. Karimdad Amir Otarodi, an orthopedic surgeon who specializes in shoulder surgery with the Eisenhower Desert Orthopedic Center, discusses rotator cuff tears, the latest treatments, and some injury prevention tips.

 This is Living Well with Eisenhower Health. I'm Scott Webb. Doctor, thanks so much for your time today. We're going to talk about the rotator cuff and what that is and what it does and how you help folks who've injured their rotator cuff. So, let's start there. What is the rotator cuff? Like, what does it do?

Dr. Karimdad Otarodi: The rotator cuff, they're the most important structures in the shoulder. They're four muscles that come off of your shoulder blade and they wrap around the top of the bone in your upper arm. So essentially, your shoulder is a ball and socket joint. The ball is the top of the bone in the arm and the socket is the edge of your shoulder blade.

Well, the rotator cuff crosses a joint and it attaches to the top of the ball, and what it does is it holds the ball centered in the socket so when other muscles pull on your arm, now the ball stays connected in there and it gives you a pivot point or a fulcrum to now rotate your shoulder. If you didn't have a rotator cuff, the other muscles attached to your arm would just pull the ball out of the socket and you'd have very poor function and a limited ability to lift your arm overhead.

Host: Yeah, absolutely. It's essential for those of us who want to use our arms for things. So, let's talk about that then. What are some of the common ways that people tear or injure their rotator cuffs?

Dr. Karimdad Otarodi: There are two ways where the rotator cuff can be injured, and it's likely a combination of the two factors that combine causing these injuries. So essentially, one is just normal age related changes to the rotator cuff. As we all get older, our rotator cuffs get thinner, the blood supply to the tendinous portion, which is a part of the muscle that connects to the bone, gets decreased. And as that happens, the rotator cuff becomes more susceptible to tearing.

There's also what we call extrinsic factors or factors outside of the tendon itself that could contribute such as overuse or contact with bone spurs and things like that that could potentially contribute to this. Before, we used to think that it was just bone spurs causing tearing in the rotator cuff, but now we know that it's really a combination of the changes within the tendon itself and also, potentially, factors outside the tendon that can lead to these injuries.

Host: Yeah, I see what you mean. So, some of it is age-related. And I think for us sports fans, we've heard of athletes tearing their rotator cuffs, be it pitchers or whomever. What are some of the symptoms of a rotator cuff tear? Is it this like sharp shooting? "Oh my gosh, I've injured my shoulder" kind of pain? Or is it something that kind of builds over time?

Dr. Karimdad Otarodi: So when it comes to the shoulder, It's actually a little bit tricky because a lot of different pathologies or issues can overlap and cause some of the same symptoms. But the most consistent complaint with someone with a rotator cuff tear is having pain in their shoulder over the rounded part right under their collarbone, and also radiating down to the upper arm. Weakness is also a common complaint and also pain at nighttime. So if you're having trouble sleeping or laying on it at nighttime, that could be a sign of a rotator cuff issue too.

Host: Yeah. So, some things to look out for. Of course, obviously if there's been some sort of acute injury, that would be obvious to us. And as you were mentioning earlier, some of this is just sort of age-related, maybe a little bit like osteoarthritis that it just begins to get worse over time. Let's talk about the healing process. Will a rotator cuff heal itself? Is that a thing? Does it heal on its own? Is there anything we can do to prevent rotator cuff injuries?

Dr. Karimdad Otarodi: Well, in terms of healing, the rotator cuff actually does not heal on its own. And when we talk about healing, we talk about there are two types of tears, really. There's partial tears, meaning that some of the rotator cuff is still touching the bone, but a portion of it is detached, but it's still essentially able to do its job. And then we talked about full thickness tears, and full means that the entire tendinous portion is pulled off the bone.

Well, the main risk is that these tears get bigger with time. They don't heal, but they could potentially get bigger. And some of the signs that, you know, the rotator cuff tear is increasing in size is if you have an acute increase in pain or weakness. And now, you're doing something at home, you move your arm and you feel a tear and now you can't lift your arm up. Those are all signs of progression of the rotator cuff tear.

Host: All right. So, it's not going to heal on its own. Are there any non-surgical things that experts like yourself can do? Or do we go right to surgery, especially if it's bad enough?

Dr. Karimdad Otarodi: A lot of it depends on the patient and the quality of the rotator cuff tear itself. So, we know that partial tears often can be treated non-operatively with physical therapy, sometimes a cortisone injection, anti inflammatories to get the pain under control. When it comes to full thickness tears, a lot of it depends on the patient and the tear size. So, in general, younger age leads to higher healing rates. So, we know that healing rates are better for patients who are ages 62 to 65 and younger. But as we get older, the propensity to heal does go down.

Smaller tears also have a much higher chance of healing than larger tears. So, we usually try to recommend going in there and doing surgery. If someone has a small to medium sized tear and they're 65 and younger and very active, then we would recommend surgery right off the bat. If they're a little bit older, let's say you're in your seventies or eighties, you have a extremely large rotator cuff tear, where we know that some of those factors can potentially decrease the healing rate, then we're more prone to saying, "You know what? Why don't we try an injection? Why don't we try some physical therapy and see if you get better before going straight to surgery?" But ultimately, it really depends on the patient, their activity level, their health and medical comorbidities, and overall their expectations and, you know, lifestyle.

Host: Yeah, I'm sure that's a big part of it, the expectations and let's talk about that. So for generally speaking, as you say, there's a range here, but for 65 and younger and healthy and reasonable expectations, how long is the recovery after surgery?

Dr. Karimdad Otarodi: It is a difficult recovery. So, usually, we keep patients immobilized for about four to six weeks, sometimes a little bit longer, depending on what we find at the time of surgery. At that point, we bring them out, we start doing some physical therapy focused on very gentle stretching and range of motion. And as time goes on, we start adding more and more to their rehab. So, ultimately, it's fair estimate to say that it's about a 10-month to 12-month recovery overall before patients hit their maximum benefit. So, it definitely is a serious recovery. It's not something where after a couple months you're back to very extensive tennis or golf or weightlifting or things like that.

Host: And mentioned there as we wrap up here, doctor, about expectations and, hopefully, patients are generally pretty reasonable. But either way, can they expect "normal", I'm putting that in quotes, "normal" function after surgery if they go through all of this 10 to 12 months and they do their part, can they expect it to be what it was before?

Dr. Karimdad Otarodi: You know, rotator cuff surgery, when the rotator cuff heals, has very, very good outcomes. Patients usually have improved function, improved pain, and they're generally very happy with the ultimate outcome once they're fully recovered. So, I'd say it usually is a very successful surgery with very happy patients once everything's said and done.

Host: Yeah. That brings a smile to my face. I always like hearing when, you know, that at some point patients will be happy. But as you say, it's a long road to recovery. They're going to have to do their part, of course, if they want to get back to some of these things, like you're saying, or be, you know, pain-free and golf and tennis, and maybe throw in a hitter on the side occasionally. So, thank you so much for your time today. You stay well.

Dr. Karimdad Otarodi: Awesome. Thank you for your time.

Host: That's orthopedic surgeon Dr. Karimdad Amir Otarodi with Eisenhower Desert Orthopedic Center. And for more information, go to eisenhowerhealth.org/orthopedics. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for additional topics of interest. I'm Scott Webb, and this has been Living Well with Eisenhower Health. Thanks for listening.