The prevalence of rotator cuff pain and injuries increases with age, most commonly appearing after age 50. The main signs of rotator cuff injuries are shoulder pain and weakness, night pain and pain when lying on the arm.
”These injuries can be the result of an acute, traumatic injury such as a fall, but more often than not they are attritional and occur over time without a discrete mechanism of injury to the patient,” said Dr. Daniel Huttman, orthopedic surgeon at Novant Health Orthopedics & Sports Medicine in Charlotte. “On exam, there may be motion loss and a decrease in strength, especially in external rotation. Patients with these complaints or patients who notice a change in their shoulder function after an acute injury such as a fall should be referred to an orthopedist for further evaluation.”
“On exam, there may be motion loss and a decrease in strength, especially in external rotation. Patients with these complaints or patients who notice a change in their shoulder function after an acute injury such as a fall should be referred to an orthopedist for further evaluation.”
Novant Health can efficiently handle X-rays and MRIs
When referring to a Novant Health orthopedist, here’s what you can expect with diagnostics, treatment options and prehab.
While plain radiographs of the shoulder along with an MRI scan of the shoulder are the gold standards of diagnostic imaging for rotator cuff injuries, primary care physicians don’t need to manage this testing prior to referring patients to orthopedic surgeons.
“If this imaging has been done, that's great,” Huttman said. “Otherwise, we are happy to see the patient with shoulder pain and take over the treatment plan, including ordering the necessary studies from that point forward.”
Personalized care plans for each patient
Novant Health orthopedic surgeons customize care plans for rotator cuff injuries based on age, activity level, mechanism of injury and the demands on the patient's shoulder.
A surgical plan establishes a timeline
While prehab can be helpful with rotator cuff tears, a surgical plan puts patients on the clock.
“Injury-specific physical therapy exercise programs are effective in mitigating the pain, swelling, stiffness and motion loss from rotator cuff injuries,” said Dr. Louis McIntyre, orthopedic surgeon at Novant Health Orthopedics & Sports Medicine in the Triad. “They can be important prior to surgery if there is loss of motion.”
“It’s not unreasonable to try physical therapy at first, and if symptoms are not improving, proceed with surgery afterwards,” said Dr. Marc Haro, orthopedic surgeon with Sports Medicine Specialists of Charleston. “But the clock does start ticking, and oftentimes the longer you wait to get into surgery for rotator cuff tears, the less likely the repair will be successful.”
New surgical treatment options
“The standard of care for rotator cuff surgery includes multiple arthroscopic treatments,” Huttman said. “New treatment approaches include repairs, tendon transfers, patches to cover a rotator cuff defect, reconstruction of the rotator cuff and an arthroscopic balloon placement in the subacromial space. Depending on the type of rotator cuff injury and the demand levels of the patient, each treatment can be tailored to the needs of each patient to ensure the best outcome possible.”
Bioinductive grafts facilitate healing
Repairs of both partial and massive cuff tears are increasingly being augmented with bioinductive collagen grafts.
Bioinductive collagen grafts can facilitate healing in rotator cuff repairs – they can support new tissue growth and structural integrity while speeding up recovery time and reducing the risk of retear. Grafting with dermal grafts is also increasing and brings similar benefits.
“For treating massive tears, there is also new technology using a biocompatible balloon spacer that is minimally invasive and simple to place,” McIntyre said. “Also for massive tears, there is an increasing trend in the recommendation of reverse total shoulder arthroplasty, especially in older patients.”
When it comes to rotator cuff injuries, orthopedic surgeons across Novant Health are accepting referrals for rapid evaluation, sometimes even same-day care. Thanks to their expertise, Novant Health is recognized as one of the best orthopedic programs in America by Becker’s Hospital Review.