If you have a rotator cuff tear, you know just how painful it can be.
The rotator cuff is a group of muscles and tendons that surround the shoulder joint.
Rotator cuff injuries occur most often in people who repeatedly perform overhead motions in their jobs or sports.
Rest, ice and physical therapy, sometimes are all that's needed to recover from a rotator cuff injury.
If your injury is severe and involves a complete tear of the muscle or tendon, you might need surgery.
Jason Garcia, MD is here to discuss your options if you have a rotator cuff injury.
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Rotator Cuff Repair
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Learn more about Jason P. Garcia, MD
Jason Garcia, MD
Jason P. Garcia, MD, specializes in sports medicine, general orthopedics, surgical and nonsurgical treatment of fractures and dislocations, and shoulder and knee surgery. Dr. Garcia's expertise includes arthroscopic rotator cuff repair, arthroscopic labral and SLAP repair, arthroscopic Bankart and instability repair, and treatment for shoulder instability, shoulder dislocation, shoulder replacement, and biceps tendon rupture repair. In addition, he is adept at knee arthroscopic anatomic ACL reconstruction, arthroscopic meniscal repair, and cartilage restoration surgery as well as acute and chronic tendonitis and tendonopathy, patellar tears and ruptures, and quadriceps and Achilles tendon repair. Dr. Garcia is Orthopaedic Consultant for the New Jersey Ballet Company.Learn more about Jason P. Garcia, MD
Transcription:
Rotator Cuff Repair
Melanie Cole (Host): When you suffer from pain in your shoulder, it could be a rotator cuff tear. It’s a common cause of pain among adults. Close to two million people in the United States went to their doctors because of rotator cuff problems. My guest today is Dr. Jason Garcia. He specializes in sports medicine, general orthopedics, surgical and non-surgical treatment of fractures, dislocations and shoulder surgery at Summit Medical Group. Welcome to the show, Dr. Garcia. Tell us a little bit, give us a little bit of a working anatomy about what the rotator cuff is and what it does for the shoulder.
Dr. Jason Garcia (Guest): Thank you for having me, Melanie. I would love to do that. The rotator cuff, simply put, is a group of four muscles which, at the end of the muscle, turns into a tendon which attaches to the upper part of the humerus bone in your shoulder. The main goal of the rotator cuff is to pull the upper end of the humerus into the socket when you are initiating shoulder movement and it really is an integral part of shoulder movement and strength specifically with overhead type movements like throwing or any other type of overhead movements.
Melanie: All of the joints are meant to do certain things but the shoulder specifically has so many movements, Dr. Garcia. How easy is it to tear one of the muscles in the rotator cuff?
Dr. Garcia: That is the thing about the shoulder is that with the great mobility and function that you get, you also have a higher chance of getting injuries or pathology. There are two real main categories of injuries. One would be a traumatic type of injury like you would get if you were tackled in a football game or fall down the stairs. Another would be overuse type injuries from repetitive activities that you do over time. The rotator cuff does actually fall into both of those categories where we see one peak of injury in younger patients who are active and another in more middle aged patients who suffer from overuse of rotator cuff--degenerative tears.
Melanie: So, for older people, so many of them that I see, Dr. Garcia, have some sort of rotator cuff injury or minor tear. They feel it when they put a jacket on, when they roll over at night onto that shoulder. What is the first line of defense? How do you know if somebody has a rotator cuff tear?
Dr. Garcia: It’s difficult to tell initially just on history and physical exam if it is, in fact, a tear because sometimes just tendonitis or some sort of early tearing could mimic a full tear with the symptoms like you describe. However, with a good history and a physical exam in the office oftentimes we can tell whether it looks more like a tear or just a tendonitis. Also, if we’re really suspicious that it may be a tear, further imagining studies may be necessary like an ultrasound of the shoulder which has no radiation as well as an MRI of the shoulder which may give us a definitive diagnosis.
Melanie: Will a rotator cuff, if it’s truly torn--even if it’s a small tear--will it heal itself?
Dr. Garcia: We look at this extensively in all of our research. If you look at the tendon as it is attached to the bone as it starts to degenerate and tear, it becomes what they call a “partial tear” until it fully extends into a full thickness tear. A full thickness tear is one where the tendon is actually detached from the bone completely. In these cases of full thickness tears, the natural history studies suggest that most of these tears do not heal on their own without surgery. Some tears may go on to not hurt or become asymptomatic; however, if you do follow up MRIs, they don’t tend to heal back to the bone.
Melanie: What would you do first if somebody is suffering from pain in that area in their shoulder? Are you an ice man? Heat man? Do you tell them to wrap it and not move it or do you tell them to try physical therapy? What do you tell them to do?
Dr. Garcia: My goal is always to get the patients better with the least invasive approach as possible. We always try a conservative approach first because, like I said, most cases will resolve or most cases are a tendonitis or an overuse without a full tear. We usually try first to remove the inciting incident, whatever is aggravating it--whether it be throwing or sports or weight lifting. Rest is important. I usually go with physical therapy, at least for a few months, to try and strengthen the muscles around the scapula to take the stress off of the rotator cuff. At that point, if there is no improvement, then usually we’re looking into further imaging studies to see if, in fact, this is a full thickness tear which may need surgical intervention.
Melanie: People hear surgical intervention and for knees and hips, it always doesn’t tend to be as complicated but, as you said, the shoulder has so many functions. Shoulder surgery always seems to be such a bigger deal. Tell us about rotator cuff tears and that it’s not that big a deal for you to fix them.
Dr. Garcia: Shoulder surgery has really advanced a lot over the last ten years. Arthroscopy, which is doing surgery through a camera looking into a joint, first evolved really in the knee and then the shoulder came after. The advancements have lagged behind the knee. However, now we’re much more advanced in the shoulder where we can do rotator cuff repair arthroscopically with minimal incisions and minimal surgical time in an outpatient setting similar to the knee. In these cases, we’re able to repair the rotator cuff and get the patients back to what they love to do with not much down time.
Melanie: Then, what is the recovery like and what is the chance that that rotator cuff might tear again, possibly in a different place?
Dr. Garcia: The biggest difficulty we see in rotator cuff surgery is getting this tendon to actually heal down to the bone. Getting tendons to heal to the bone is the most difficult type of healing. The surgery is done as a same-day outpatient surgery where we repair the tendon to the bone and then the patients are usually in a sling for about four to six weeks. They’re allowed to come out of the sling to use their elbow, wrist and hand to do tasks with their arm at their side, but they are limited with raising their arm up over head for the first six weeks. After that, it’s progressive physical therapy and strengthening and usually return to all activities happens within six months. There are many new techniques that we’ve developed to try and get the tendon to heal down to the bone. One of them, particularly, being a double row rotator cuff repair which we fix the rotator cuff at multiple points in order to increase the strength. Now we’re seeing patients return even quicker and get better even quicker and with a better healing rate. However, the healing rates can be limited in certain patients who are at a higher risk for not healing. Specifically, patients who are more elderly, patients who smoke or other patients who may have comorbidity or diabetes.
Melanie: Dr. Garcia, people go for cortisone injections in their shoulder all the time. How many of those can you get before you’ll say to somebody, “This just isn’t working for you. This thing is torn and this isn’t going to help you anymore”?
Dr. Garcia: I do use cortisone in my practice. One way to look at it is, I give anti-inflammatory medicine right in the place that we want it without having the other systemic side effects. It can be an effective tool in decreasing inflammation initially. However, if that inflammation returns after an injection or it doesn’t work, it’s a sign to me that something more serious may be going on and in those cases, I usually jump to getting more advanced imaging studies and looking to augment the problem with either surgery or other methods like platelet rich plasma instead of going forward with multiple cortisone injections. I usually use them initially but then, after that, go to other methods.
Melanie: In just the last few minutes, Dr. Garcia, give your best advice about possible prevention of rotator cuff injuries and really what you want the listeners to know.
Dr. Garcia: Prevention of rotator cuff injuries is really focused at keeping a good posture and keeping your scapula, which is your shoulder blade, turned in to the right position. Most cases of these tears occur because we have a tipping forward of the scapula, which is the shoulder blade, which occurs from a lot of sitting, rounding of the back, using a mouse or devices and having just generalized weakness around the scapula. Generally, I recommend patients do posture strengthening exercises and also periscapular muscular strengthening exercises to keep their shoulders strong.
Melanie: And why should patients come to Summit Medical Group for their care?
Dr. Garcia: Summit Medical Group is a multispecialty group where we can do “one stop shopping”, where you can come and see me and we can obtain the proper imaging studies. We have the technologies to do the injections, surgeries, bracing--anything we need to get the patients better and back to doing what they love to do as quickly as possible. We have well trained, specialty trained doctors who can provide that care for the patients.
Melanie: That you so much, Dr. Garcia. It’s a great bit of information. You’re listening to SMG Radio. For more information you can go to SummitMedicalGroup.com. That’s SummitMedicalGroup.com. This is Melanie Cole. Thanks so much for listening.
Rotator Cuff Repair
Melanie Cole (Host): When you suffer from pain in your shoulder, it could be a rotator cuff tear. It’s a common cause of pain among adults. Close to two million people in the United States went to their doctors because of rotator cuff problems. My guest today is Dr. Jason Garcia. He specializes in sports medicine, general orthopedics, surgical and non-surgical treatment of fractures, dislocations and shoulder surgery at Summit Medical Group. Welcome to the show, Dr. Garcia. Tell us a little bit, give us a little bit of a working anatomy about what the rotator cuff is and what it does for the shoulder.
Dr. Jason Garcia (Guest): Thank you for having me, Melanie. I would love to do that. The rotator cuff, simply put, is a group of four muscles which, at the end of the muscle, turns into a tendon which attaches to the upper part of the humerus bone in your shoulder. The main goal of the rotator cuff is to pull the upper end of the humerus into the socket when you are initiating shoulder movement and it really is an integral part of shoulder movement and strength specifically with overhead type movements like throwing or any other type of overhead movements.
Melanie: All of the joints are meant to do certain things but the shoulder specifically has so many movements, Dr. Garcia. How easy is it to tear one of the muscles in the rotator cuff?
Dr. Garcia: That is the thing about the shoulder is that with the great mobility and function that you get, you also have a higher chance of getting injuries or pathology. There are two real main categories of injuries. One would be a traumatic type of injury like you would get if you were tackled in a football game or fall down the stairs. Another would be overuse type injuries from repetitive activities that you do over time. The rotator cuff does actually fall into both of those categories where we see one peak of injury in younger patients who are active and another in more middle aged patients who suffer from overuse of rotator cuff--degenerative tears.
Melanie: So, for older people, so many of them that I see, Dr. Garcia, have some sort of rotator cuff injury or minor tear. They feel it when they put a jacket on, when they roll over at night onto that shoulder. What is the first line of defense? How do you know if somebody has a rotator cuff tear?
Dr. Garcia: It’s difficult to tell initially just on history and physical exam if it is, in fact, a tear because sometimes just tendonitis or some sort of early tearing could mimic a full tear with the symptoms like you describe. However, with a good history and a physical exam in the office oftentimes we can tell whether it looks more like a tear or just a tendonitis. Also, if we’re really suspicious that it may be a tear, further imagining studies may be necessary like an ultrasound of the shoulder which has no radiation as well as an MRI of the shoulder which may give us a definitive diagnosis.
Melanie: Will a rotator cuff, if it’s truly torn--even if it’s a small tear--will it heal itself?
Dr. Garcia: We look at this extensively in all of our research. If you look at the tendon as it is attached to the bone as it starts to degenerate and tear, it becomes what they call a “partial tear” until it fully extends into a full thickness tear. A full thickness tear is one where the tendon is actually detached from the bone completely. In these cases of full thickness tears, the natural history studies suggest that most of these tears do not heal on their own without surgery. Some tears may go on to not hurt or become asymptomatic; however, if you do follow up MRIs, they don’t tend to heal back to the bone.
Melanie: What would you do first if somebody is suffering from pain in that area in their shoulder? Are you an ice man? Heat man? Do you tell them to wrap it and not move it or do you tell them to try physical therapy? What do you tell them to do?
Dr. Garcia: My goal is always to get the patients better with the least invasive approach as possible. We always try a conservative approach first because, like I said, most cases will resolve or most cases are a tendonitis or an overuse without a full tear. We usually try first to remove the inciting incident, whatever is aggravating it--whether it be throwing or sports or weight lifting. Rest is important. I usually go with physical therapy, at least for a few months, to try and strengthen the muscles around the scapula to take the stress off of the rotator cuff. At that point, if there is no improvement, then usually we’re looking into further imaging studies to see if, in fact, this is a full thickness tear which may need surgical intervention.
Melanie: People hear surgical intervention and for knees and hips, it always doesn’t tend to be as complicated but, as you said, the shoulder has so many functions. Shoulder surgery always seems to be such a bigger deal. Tell us about rotator cuff tears and that it’s not that big a deal for you to fix them.
Dr. Garcia: Shoulder surgery has really advanced a lot over the last ten years. Arthroscopy, which is doing surgery through a camera looking into a joint, first evolved really in the knee and then the shoulder came after. The advancements have lagged behind the knee. However, now we’re much more advanced in the shoulder where we can do rotator cuff repair arthroscopically with minimal incisions and minimal surgical time in an outpatient setting similar to the knee. In these cases, we’re able to repair the rotator cuff and get the patients back to what they love to do with not much down time.
Melanie: Then, what is the recovery like and what is the chance that that rotator cuff might tear again, possibly in a different place?
Dr. Garcia: The biggest difficulty we see in rotator cuff surgery is getting this tendon to actually heal down to the bone. Getting tendons to heal to the bone is the most difficult type of healing. The surgery is done as a same-day outpatient surgery where we repair the tendon to the bone and then the patients are usually in a sling for about four to six weeks. They’re allowed to come out of the sling to use their elbow, wrist and hand to do tasks with their arm at their side, but they are limited with raising their arm up over head for the first six weeks. After that, it’s progressive physical therapy and strengthening and usually return to all activities happens within six months. There are many new techniques that we’ve developed to try and get the tendon to heal down to the bone. One of them, particularly, being a double row rotator cuff repair which we fix the rotator cuff at multiple points in order to increase the strength. Now we’re seeing patients return even quicker and get better even quicker and with a better healing rate. However, the healing rates can be limited in certain patients who are at a higher risk for not healing. Specifically, patients who are more elderly, patients who smoke or other patients who may have comorbidity or diabetes.
Melanie: Dr. Garcia, people go for cortisone injections in their shoulder all the time. How many of those can you get before you’ll say to somebody, “This just isn’t working for you. This thing is torn and this isn’t going to help you anymore”?
Dr. Garcia: I do use cortisone in my practice. One way to look at it is, I give anti-inflammatory medicine right in the place that we want it without having the other systemic side effects. It can be an effective tool in decreasing inflammation initially. However, if that inflammation returns after an injection or it doesn’t work, it’s a sign to me that something more serious may be going on and in those cases, I usually jump to getting more advanced imaging studies and looking to augment the problem with either surgery or other methods like platelet rich plasma instead of going forward with multiple cortisone injections. I usually use them initially but then, after that, go to other methods.
Melanie: In just the last few minutes, Dr. Garcia, give your best advice about possible prevention of rotator cuff injuries and really what you want the listeners to know.
Dr. Garcia: Prevention of rotator cuff injuries is really focused at keeping a good posture and keeping your scapula, which is your shoulder blade, turned in to the right position. Most cases of these tears occur because we have a tipping forward of the scapula, which is the shoulder blade, which occurs from a lot of sitting, rounding of the back, using a mouse or devices and having just generalized weakness around the scapula. Generally, I recommend patients do posture strengthening exercises and also periscapular muscular strengthening exercises to keep their shoulders strong.
Melanie: And why should patients come to Summit Medical Group for their care?
Dr. Garcia: Summit Medical Group is a multispecialty group where we can do “one stop shopping”, where you can come and see me and we can obtain the proper imaging studies. We have the technologies to do the injections, surgeries, bracing--anything we need to get the patients better and back to doing what they love to do as quickly as possible. We have well trained, specialty trained doctors who can provide that care for the patients.
Melanie: That you so much, Dr. Garcia. It’s a great bit of information. You’re listening to SMG Radio. For more information you can go to SummitMedicalGroup.com. That’s SummitMedicalGroup.com. This is Melanie Cole. Thanks so much for listening.