Dr. Seng: 'Shoulder Pain? A Rotator Cuff Tear Could Be the Problem.'

Rotator cuff tears can happen at any age but are more likely to happen as we get older.

“In fact, by the time you reach 60 years old, there’s a good chance you’ll have some partial or complete rotator cuff tears. These tears can limit movement and, for many people, cause serious shoulder pain that affects work, play and sleep,” orthopedic surgeon Khemarin Seng, MD, told a crowd of nearly 175 people during a free health lecture held on Aug. 22 in Boulder.

The rotator cuff is a group of muscles and tendons that form a covering around the head of your upper arm bone (humerus). The rotator cuff attaches the humerus to the shoulder blade and helps you lift and rotate your arm.

“When one or more of the rotator cuff tendons becomes torn, the tendon is no longer fully attached to the head of the humerus,” Dr. Seng explained. “Rotator cuff tendons can wear down with age, leading to tears. Overuse from everyday activities or exercise — for example, doing yard work or playing tennis — can also cause this injury. So can an accident such as falling on your arm or lifting something heavier than you should.”

How Do You Know When It’s a Tear?
If a rotator cuff tear happens after an injury, symptoms can occur immediately. If the tear happens gradually, then symptoms tend to get worse over time.

“However, not all rotator cuff tears cause pain. About 40 percent of them have no symptoms and can go unnoticed,” Dr. Seng stated. “Only a visit to a physician can give you an accurate diagnosis of a rotator cuff tear. But there are symptoms to be aware of."

Symptoms of a rotator cuff tear include:

• a dull achy pain deep in the shoulder
• pain or tenderness when reaching overhead
• pain in the front of the shoulder that radiates down the side of your arm
• weakness in your arm
• difficulty sleeping on the injured shoulder
• difficulty getting a full range of shoulder motion
• a locking or catching sensation in your shoulder

Diagnostic Process
“The diagnostic process for rotator cuff tears typically starts with a patient interview and history. I’ll ask when and where you have your pain, what your occupation is, the sports you engage in and whether you’ve experienced trauma in your shoulder,” Dr. Seng said.

After the interview, Dr. Seng performs a physical examination to assess the rotator cuff. He will test your posture, muscle development and the shoulder joint, particularly the front, which is commonly affected. “I’ll then test the rotator cuff muscles in isolation, and perform some provocative tests, which can frequently isolate rotator cuff tears,” he said.

If a rotator cuff tear is suspected, he may order imaging tests such as x-ray, ultrasound, arthroscopy, CT arthrograms or MRI.

“MRI has been the gold standard for diagnosing rotator cuff injuries because it provides an amazingly detailed and accurate cross-sectional view of the shoulder, showing both complete and partial rotator cuff tears,” according to Dr. Seng. “Yet recent studies have indicated that ultrasound and MRI are comparable in both sensitivity and specificity, which is why ultrasound is gaining more acceptance in the U.S. for diagnosing tears.”

Evaluating Your Treatment Options
While tears sometimes require surgery, a physician might suggest a wait-and-see approach or prescribe nonsurgical treatment. Some tears can be treated with physical therapy, anti-inflammatory medication, a sling or brace to limit shoulder movement and injections, including steroids, platelet rich plasma, prolotherapy and stem cells.

“Since there is a wide range of treatments for most rotator cuff tears, you'll want to understand your options before you make a decision,” Dr. Seng advised. To help with the decision, here are questions he suggested you ask your provider:

• Do I have a partial or full thickness tear?
• How severe is it?
• What are the expected outcomes of my treatment options?
• What would you do if this were your shoulder?

When Is It Time for Surgery?
Dr. Seng said rotator cuff surgery is often the best option when sudden weakness and pain follows a shoulder injury or when non-surgical treatments are no longer helpful.

There are different approaches to surgery, depending upon whether it’s a partial or complete tear. “A partial tear may need only a smoothing procedure to even out the roughness from the tear. A complete tear is fixed by re-attaching the tendon back to its original site on the humerus,” Dr. Seng said.

Khemarin Seng, MD, has more than 15 years experience in successfully treating shoulder problems. To schedule an appointment, call 303-449-2730.

Click here to view PowerPoint slides from Dr. Seng’s lecture on “Relieving Shoulder Pain: Treatment Innovations for Rotator Cuff Injuries.”

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