Navigating the Health Care System

It's a fact of life: as we get older, we're more likely to get hurt when we exercise or take on certain everyday tasks. Routine activities like playing tennis or placing items on shelves can result in a common problem—the rotator cuff injury.

Tears in the rotator cuff are not a huge health setback. But they can limit movement and cause serious pain. There are several ways to treat rotator cuff tears, including surgery and non-surgical treatments. You'll want to understand your options before you make a decision.

To help you, my agency, the Agency for Healthcare Research and Quality (AHRQ), offers a guide called Treatment Options for Rotator Cuff Tears. It explains in plain language how this common, age-related injury is treated and the pros and cons of ways to treat it.

The good news is that most treatments work. But some options may be better for certain patients. For example, older or sicker patients often do better without surgery.

Knowing how your rotator cuff works helps you understand how it can be injured. The rotator cuff is a group of four muscles and tendons that hold the "ball" of your upper arm bone firmly in your shoulder socket. Your rotator cuff allows you to lift and rotate your arms. The tendons can tear much like a piece of leather. Sometimes, the tendon is only slightly damaged. Other times, the tendon suffers a complete tear, meaning that it has torn away from the bone.

Rotator cuff injuries are more common as we age. More than half of adults older than 60 have a partial or complete rotator cuff tear compared to only 4 percent of adults under 40. Natural wear and tear can cause this injury. An accident, such as falling, can also cause your rotator cuff to tear. So can overuse from repeated actions, such as lifting, painting, or throwing.

To choose a treatment, it's important to know how non-surgical and surgical treatments compare for their ability to relieve pain and restore movement and function. There are three common ways to treat such tears without surgery: physical or occupational therapy; oral medicines, such as acetaminophen or "nonsteroidal anti-inflammatory drugs;" or steroids taken as a pill or an injection.

Your doctor will make a recommendation based on the damage to the tendon of your rotator cuff. Physical therapy may be enough to improve the pain and weakness, or surgery may be a better choice. In some cases when physical therapy does not improve symptoms, surgery is needed.

In most rotator cuff repair surgeries, a surgeon stitches the torn edges of the muscle or tendon back together or connects the tendon back to the ball of your upper arm bone. The three types of surgery to treat a rotator cuff tear are:

• Arthroscopic surgery: The surgeon makes very small cuts into the muscles of your shoulder and uses an arthroscope (a small tube attached to a camera and tiny surgical instruments) to repair the tear.
• Open surgery: The surgeon makes a larger opening into the muscles of your shoulder and repairs the tear with regular surgical instruments.
• Mini-open surgery: The surgeon uses an arthroscope for the first part of the surgery and then makes an opening large enough to use other surgical instruments for the repair.

Our guide, Treatment Options for Rotator Cuff Tears, summarizes scientific evidence. It shows that patients get better with both non-surgical and surgical treatments. Three types of surgery all produce the same level of improvement of shoulder function. However, arthroscopic surgery usually offers a shorter recovery time. A few studies found that some patients who had mini-open surgery returned to work or sports about 1 month sooner than those who had open surgery.

To decide what is right for you, consider asking your doctor questions such as:

1. What are the pros and cons of non-surgical or surgical treatments for me?
2. If I need surgery, which type (open, mini-open, or arthroscopic) do you think would be best for me?
3. What type of care will I need after surgery?
4. When can I return to my usual activities?
5. Will these treatments help my rotator cuff for many years?
6. When should I expect to feel better?

Getting information about the risks and benefits of different treatments helps you make an informed decision. And we know that informed patients often have a shorter path to better health.

I'm Dr. Carolyn Clancy, and that's my advice on how to navigate the health care system.

More Information

Agency for Healthcare Research and Quality
Treatment Options for Rotator Cuff Tears: A Guide for Adults