Treatment Options for Painful Rotator Cuff

Q:  Can I live with a rotator cuff tear in my left shoulder without ruining my arm totally? My doctor told me the tear will not mend on its own and surgery is the best correction if the injury is not too old.

My shoulder has been bothering me for months and interferes with my sleep. I am an 83-year-old widow living alone in a mobile home and I want to stay reasonably active.

A:  The rotator cuff consists of a group of tendons and muscles that helps hold the ball in the shoulder joint socket and provides mobility and strength to the shoulder joint.

One or more rotator cuff tendons can become inflamed from overuse, aging, a fall on an outstretched hand, or a collision. Sports requiring repeated overhead arm motion or occupations requiring heavy lifting also place a strain on rotator cuff tendons and muscles. Normally, tendons are strong, but a longstanding wearing down process may lead to a tear.

Typically, a person with a rotator cuff injury feels pain over the deltoid muscle at the top and outer side of the shoulder, especially when the arm is raised or extended out from the side of the body. Motions like those involved in getting dressed can be painful. The shoulder may feel weak, especially when trying to lift the arm into a horizontal position. A person may also feel or hear a click or pop when the shoulder is moved.

Rotator cuff problems are common in the older shoulder. (No, a rotator cuff tear is not just for baseball players!) According to Dr. Steven Grindel, Assistant Professor of Orthopaedic Surgery at the Medical College of Wisconsin, the answer to your question is yes, you can live with the tear, and it is reasonable to try physical therapy, cortisone injections and anti-inflammatory medications such as ibuprofen if you want to avoid surgery. In some cases your symptoms will go away, but in other cases the tear will get worse.

Dr. Grindel considers shoulder surgery rewarding work because it is so frequently helpful. Although the recovery period may be difficult since you are living alone, in the end the surgery might allow you to maintain independence longer. So, with your degree of symptoms, surgery may be the best option.

Julie L. Mitchell, MD, MS, is an Assistant Professor of Medicine at the Medical College of Wisconsin. She practices internal medicine at the Froedtert & Medical College General Internal Medicine Clinic - East. Her column appears in the Milwaukee Journal-Sentinel.