When people think of what orthopedic surgeons do in their everyday practice, fixing broken bones likely comes to mind. In fact, injuries to the soft tissues that support and move us at our joints are just as commonly the reason why patients present to my office, and one of the most frequently evaluated causes of significant upper arm pain and dysfunction in folks over the age of 50 is tearing of tendons that attach the rotator cuff muscles to the bones around our shoulder joints. As an orthopedic sports medicine specialist, this is an area I have great interest in treating.
Our shoulder joints provide us with a higher degree of freedom of movement than any other joint in the human body and are essentially structured like a ball resting in a socket. Unlike the similarly structured hip joint, however, the bony sockets in our shoulder joints are quite shallow. One of the best ways to think about the importance of our rotator cuff muscles and their tendons to the normal function and movement of the shoulder is to imagine the shoulder joint as a golf ball resting on a tee. A brisk wind could easily blow the ball off the tee, and so our shoulders must rely on something else to keep the ball in the socket, and this is where the dynamic function of the rotator cuff envelope of muscles and tendons plays a role. As the larger outer deltoid muscles work to ultimately raise our arms over our heads, it’s the rotator cuff that keeps the ball of the arm bone stabilized in the socket of the shoulder blade.
Tears of the rotator cuff tendons lead to interference with regard to this stabilizing function and make their presence known with significant pain. Sometimes these tears occur as a result of a notable injury like a trip-and-fall accident, and other times they develop more slowly and insidiously due to overuse of the arm where, as a result of getting a bit older, we are not able to heal these small tears when they happen, resulting in them getting bigger over time. As you can imagine, when part of the tendon tears away from the bone where it should normally attach, this leads to more stress at the neighboring site where the tendon still partially attaches, and it is this increased tension that people experience as the pain of a tendon tear.
Not all rotator cuff tendon tears need surgery, but in those situations where the pain doesn’t improve adequately over time with treatment like physical therapy, surgery is considered to put the torn tendon back where it belongs by repairing it to bone. This is one of my areas of surgical expertise where minimally invasive surgery with a focus on restoring a person’s normal anatomy can make a big difference to improving their shoulder function and pain.
In my experience, the key to a successful outcome after rotator cuff repair surgery is a strong repair of the tendon and being able to get the shoulder moving as soon as possible with the help of professional physical therapy. When I perform a repair, my aim is to reattach the torn tendon to bone with as many contact points as possible. Doing so distributes the forces imposed on the repair evenly so that patients have less pain after surgery. In my practice, this is exemplified by many patients requiring pain medication for only a few days after surgery. There are other factors that influence how a person recovers after rotator cuff repair surgery, but the integrity of the repair is most important. In joining the Center for Musculoskeletal Disorders, I look to bring this approach to every such patient I am privileged to treat.
By Dr. Donald Heitman
Dr. Donald Heitman, MD is a sports medicine specialist in New York, NY and has been practicing for 13 years. He graduated from New York Univ Sch Of Med in 2005 and specializes in sports medicine.
