Shoulder Questions

How could my rotator cuff tear without any injury?

Although in younger patients trauma can cause a rotator cuff to tear, this is relatively uncommon. The rotator cuff, as with some other tissues and tendons we all have, can progressively get weaker as we all get older. Its blood supply becomes compromised. It is therefore becomes more prone to injury or simply tearing without any history of injury. Over the age of 70, there is a significant incidence of rotator cuff tears without any history and many times even without symptoms.

What is the difference between X-rays and an MRI?

X-rays and a CT scan both use radiation to visualize structures, mostly bones in the body. But, an MRI uses a magnetic field to visualize not only the bones but also the soft tissues around the bones. For diagnosis of Osteoarthritis or bone spurs in the shoulder, routine x-rays are good. But, to visualize a torn rotator cuff, torn biceps tendon, or other soft tissue problems, the MRI is best and without the radiation.

What is the recovery time after shoulder arthroscopy?

Shoulder arthroscopy typically is done as an outpatient, meaning you go home the same day. To simply remove bone spurs, the recovery is usually about 6-8 weeks. Rotator cuff surgery is different. You are usually in a shoulder immobilizer for 3 weeks although you will start your home exercises the next day and PT after your first office visit. Physical therapy usually lasts a minimum of 12 weeks but can last longer dependent upon the size of your particular tear, your progress and your job obligations.

When will I get my strength back after surgery?

Following arthroscopy the most important priority is protection of the rotator cuff repair while at the same time slowly increasing motion. There will be a sequence in the therapy to help you regain your motion. But, strength is not a priority until after you regain some motion. The mechanics of the shoulder need to be regained before starting to strengthen the shoulder. Strengthening is a matter of strengthening and balancing muscle groups of the rotator cuff, the scapula, the back and the abdominal core. Strength return depends on your pre-operative muscle tone. But, your ability to gain enough strength to return to your occupation obviously depends upon your job obligations.

Can I re-tear my rotator cuff?

The short answer is Yes – The reason many people tear their rotator cuff in the first place is a combination of age, intrinsic weakening of the rotator cuff and in some cases bone spurs. Bone spurs are eliminated at the time of original operative procedure. But the intrinsic weakness of the cuff is still there after repair. Newer techniques have dramatically negated these problems. Newer ideas of mechanics, newer devices to help secure the rotator cuff, newer ideas to help increase healing and blood supplies all have decreased but not eliminated the risk of re-tear. As a general rule, older patients and larger tears have higher risks of re-tear.

Can I do more exercises than what the doctor and therapists have given me?

Actually people with more aggressive personalities need to be reigned back-in a little. The problem is that after surgery they start to feel better and think they can do anything. But, the reality is that they cannot speed along physiology and it takes some finite amount of time for a rotator cuff to heal. While it is healing it must be protected to some degree. It is better to abide by the instructions of your doctor and therapist as they will speed you along as much as possible while still protecting the repair and decreasing your risk of re-injury.

What causes loss of strength in the arm and shoulder?

There are many causes of loss of strength, loss of motion, or any type of dysfunction of the shoulder. But, the most common broad two categories are rotator cuff tears and pinched nerves. Rotator cuff tears cause loss of motion, painful limited motion, and strength loss. A pinched nerve causes strength loss and numbness. In some cases the symptoms are very similar. A complete history and physical examination are usually required to sort-out the differences.

How long will I be off work after shoulder surgery?

Shoulder surgery is an inconvenience. If it is your dominant arm and you are in an immobilizer post-operatively, then you will have some difficulty with basic things for about three weeks. Once the immobilizer comes off, you tend to progress more quickly. People in clerical jobs, sedentary jobs, managerial jobs, and some professional jobs will be able to get back to work quicker, in about 2-4 weeks though they will still be in physical therapy. Those who have more labor intensive jobs which require strength or working over head may not be able to return to work for 3-4 months. However, some very large rotator cuff tears heal exceptionally slowly and may never offer the person the ability to return his former occupation if that job has intensive lifting or carrying obligations.

How do you control pain after shoulder surgery? I hear it is very painful.

Shoulder surgery has matured over the last two decades. Techniques of shoulder surgery have now allowed us to do almost everything except replacement or fractures with an arthroscope. That allows surgery without cutting into the muscles. Anesthesia has also changed. The anesthesiologists now have perfected the use of special nerve blocks. This keeps the arm comfortable after the operation for as long as 24-36 hours after which the arm slowly wakes up. The operation is not pain free but the combination of these new technologies makes the operation particularly tolerable and most of our patients need only five to ten pain pills post operatively.

What is a frozen shoulder?

A frozen shoulder or adhesive capsulitis is a condition often seen in middle aged females. It commonly associated with diabetes or thyroid problems. The capsule or covering of the shoulder clamps down onto the ball of the shoulder and prevents it from spinning in its cup. The treatment is usually physical therapy and medications. This is designed to stretch the capsule and allow the ball to spin. In most cases, therapy alone, without surgery will relieve the symptoms. In some cases surgery is required to cut the capsule.