Solutions
for painful shoulders
Ron Clark, M.D.
South Bend Clinic
One
of the painful problems with the shoulder involves the muscles
known as the "rotator cuff." This part of the shoulder represents
the muscles that go from the shoulder blade and attach to
the top part of the arm. There are four separate muscles that
come together over the shoulder joint and fuse together so
that at the arm they are essentially all one continuous sheet
of tissue termed tendon. These muscles allow us to rotate
the arm on the shoulder (as in throwing a ball) and can have
a variety of problems develop from use, overuse or injury.
As
we age, the rotator cuff tendon sometimes fails or tears.
The diagnosis can be suspected based on the physical examination
but confirmation is usually obtained by getting a picture
of the tissue by doing a MRI scan. The MRI involves lying
motionless on a machine that uses a magnetic field and sound
waves to develop a picture of the body. The picture of the
shoulder can show tendon damage, partial tearing, or complete
tearing. When the diagnosis of a rotator cuff tear is made,
the treating physician will often give the patient the option
of either immediate surgical repair, or an attempt at non-surgical
treatment with steroid injections and muscle exercises. This
is a very controversial subject amongst shoulder specialists
because good reasons exist for either decision. It is known
that of persons over 60 years of age, 1 in 10 will have a
torn rotator cuff tendon and will not be aware of it. For
those over 70 years, the rate is 3 out of 10. That means that
many people can function just fine with their "torn" rotator
cuff. Many reports exist in the medical journals showing that
a third or more of patients will in fact get better after
a diagnosis of rotator cuff tear without surgery. Unfortunately
most do not improve and are unhappy with their shoulder.
It
should be obvious that a small tear is more easily repaired
than a large tear and there are some tears that are so large
that they cannot be repaired. So does a person live with his
small "repairable" rotator cuff tear and wait until it becomes
a "big" tear before getting surgery? Or is it better for the
patient to get surgery immediately so that the tear can hopefully
be repaired before it becomes irreparable? There is really
no way that anyone can reliably know the future of any particular
patient. In cases such as this it is up to the doctor to fully
inform that patient as to the risks and benefits of the surgical
repair versus the option of waiting and watching. Ultimately
the patient will need to participate in the responsibility
for the decision with the doctor. Each situation is different,
as the individual's age, lifestyle, occupation, associated
medical conditions, and hand dominance need to be considered.
Over
the past 6 years I have been finding that many rotator cuff
tears can be repaired through small incisions using the arthroscope
(surgical telescope) and patients have had less pain and scarring
as a result. The research that I have analyzed as a result
of my experience leads me to conclude that small tears are
better corrected early before they become large and irreparable.
