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,” said orthopedic surgeon Khemarin Seng, MD, of Boulder Center for Orthopedics during a free Boulder Community Health online lecture.

VIDEO: Watch Dr. Seng's online lecture on "Relieving Shoulder Pain"

What is the Rotator Cuff?

The shoulder joint is made up of the upper arm bone (humerus) and the shoulder blade (scapula). The rounded end of the humerus moves inside a shallow socket in the scapula.

The rotator cuff is a group of muscles and tendons that form a covering around the head of the humerus. The rotator cuff attaches the humerus to the scapula 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 provide 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 an x-ray, ultrasound, arthroscopy, CT arthrogram 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

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

• Do I need surgery or injections?
• What if I just leave it alone?
• Do I have a partial, half, one-quarter or full thickness tear?
• How severe is it?
• What are common surgical and non-surgical strategies and interventions?
• What are the expected outcomes of these treatment options?
• Will you be treating the pain or dysfunction?
• What would you do if this were your shoulder?

A Single Assessment Numerical Evaluation, or S.A.N.E score, is often used to understand what level of pain a patient is experiencing. Dr. Seng suggests, “Discussing your S.A.N.E. score with your provider can help you decide on the best treatment. You'll also want to consider your personal goals.”

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 or with injections, including steroids, platelet rich plasma, prolotherapy and stem cells.

Surgical Treatment Innovations

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.

Arthroscopy is currently the gold standard for rotator cuff repair. This procedure requires one or two very small incisions to allow for the insertion of a tiny camera. A surgeon then uses specially designed instruments to repair the tear.

Dr. Seng then described several surgical innovations that have grown in popularity at an astonishingly rapid rate:

• Arthroscopic superior capsular reconstruction allows surgeons to put a “patch” on a tear that is irreparable. “This new minimally invasive option,” said Dr. Seng, “is a great pain-relieving procedure.”
• Reverse total shoulder replacement as explained by Dr. Seng, “Is done in an arthritic shoulder that has a large rotator cuff tear, when the muscles no longer function.” The major difference between a standard shoulder replacement and a reverse total shoulder replacement is the ball and socket implants of the shoulder joint switch sides. As a result, the deltoid muscle, instead of the rotator cuff, will power and position the arm. Dr. Seng explained, “This type of shoulder replacement is very successful and requires minimal time for rehabilitation.”
• InSpace balloons is still in the trial phase and not available to the public. This procedure uses a balloon spacer that fits between the shoulder’s scapula and the humerus to relieve pain in cases where a patient is having a bone-on-bone issue.

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

View/download a PDF of slides shown during Dr. Seng’s lecture on “Relieving Shoulder Pain: Treatment Innovations for Rotator Cuff Injuries.”

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