Your shoulder is a complicated joint. When most people think about their shoulder, they think about the ball and socket, and the larger muscles surrounding the joint, like the bicep and deltoid. But there’s a lot going on underneath that helps to make the joint work properly – including the rotator cuff.

Nearly two million patients in the United States visited their doctor in 2013 due to a rotator cuff problem. How serious is a tear to the rotator cuff? We asked Dr. Russell Bear, a shoulder, elbow and sports medicine surgeon, to explain exactly what the rotator cuff is and what it means to injure this group of muscles. Dr. Bear practices at our Chesapeake Orthopaedic and Sports Medicine care center in Glen Burnie and Hanover.

What is the rotator cuff?

The rotator cuff is a group of muscles that attach to the ball, or top, of the humerus bone to keep the ball and socket in place. The rotator cuff also helps to position the arm, but relies on the bigger muscles around the shoulder to move properly. One of the analogies that I use for the rotator cuff is the old tube televisions, when you had to get up and turn the dial on the TV. You had a course tune and a fine tune button to dial the quality of the picture you had. The large muscles like the chest and deltoid serve as the course tune button. The rotator cuff is the fine tune button that makes everything nice, crisp and clear and helps the arm to move smoothly.

What does it mean to tear your rotator cuff?

It’s not necessarily a muscle tear, but a tear in the tendon of those muscles. They all join and form a common tendon that wraps around the ball of the joint. There is usually a tear in that tendon attaching to the ball or humerus bone. That tear is what causes pain and sometimes weakness.

How can you tear your rotator cuff?

Many patients have a little bit of pain beforehand because of impingement syndrome or have a vague achiness related to bursitis or inflammation. But something typically triggers the injury to the tendon like a fall on an outstretched hand or a lifting injury, when a weight falls and the patient tries to catch it or they lift something heavier than they should.

A lot of people think of baseball players as classic rotator cuff injury patients, but those patients probably only make up about 5% of the rotator cuff injuries that I see in my practice. I see a lot more weekend warriors, people who are doing yard work or patients who tripped on a step and tried to catch themselves from falling.

How might a patient know if they tore their rotator cuff? What are the symptoms?

The most common symptom of a rotator cuff tear is pain, and pain that isn’t getting better with conservative treatments like ice, rest, anti-inflammatories and avoiding sports or exercise activity. Some patients also experience weakness, which leads us to operate a little quicker.

How do you treat a rotator cuff tear? Is surgery required?

It depends on the degree of injury to the rotator cuff. You can have a partial thickness tear, where a portion of the cuff is still well attached to the bone, but there are some fibers that have pulled off. The majority of partial thickness tears do perfectly fine with non-operative treatment like cortisone shots and physical therapy. If it is a full thickness tear, older patients can undergo that conservative treatment, too.

The patients who have weakness and difficulty lifting their arm over their head with no weight typically require surgery. There are also patients who initially come in because of pain but the pain doesn’t subside after the conservative treatment of cortisone shots and physical therapy. We recommend surgery for those patients to address pain and weakness.

Are there different surgical options to treat the rotator cuff tear?

The classic surgical treatment is through an open incision, but as surgeons, we are much more capable with arthroscopy today, so that is probably becoming the standard surgical treatment for a rotator cuff tear. Some larger tears are still treated through an open incision, but it really depends on which specific tendon is injured. I still do occasional open repairs for the front rotator cuff tendon, the subscapularis, but it comes down to the surgeon’s comfort and preference.

How long is the recovery process?

Some partial thickness injuries that need shoulder arthroscopy to remove damaged tendon tissue can expect a full recovery in about three months. However, for a full thickness tear in which the tendon is pulled off the bone, patients are often in a sling for 4-6 weeks after surgery for rest and healing, then they can use their arm for light activity at around three months. They still need to be cautious and we’ll release them for regular activities at six months. They may still experience soreness off and on until about a year later. It’s typically a six month to one year process, but at the end, the patient will be happy.

Are patients at risk of tearing their rotator cuff again in the future? What can be done to prevent a future rotator cuff tear?

Our bodies have their limitations. Once you have an injury you are a little more susceptible to re-injury in the future. Unfortunately when the tendon heals it can do well and you can be quite strong, but it’s not completely normal tendon tissue afterwards, so patients need to work smarter and not harder.

The number one prevention tactic is to stop smoking if you are a smoker. Beyond that, after surgery you need to modify activities based on your injury and your age. Manual laborers need to take their time when they do lifting activities. Recreational weekend warriors need to respect their body and its limitations to avoid re-injury. Sure, when you’re young you think you can push through, but older patients need to be very careful and might want to dial back on how frequently they are lifting and how much they lift.

Dr. Russell Bear specializes in disorders of the shoulder and elbow and sports medicine injuries at our Chesapeake Orthopaedic & Sports Medicine care center in Glen Burnie and Hanover. He has attained a well-rounded background in orthopaedic surgery after 12 years with the U.S. Army. He was awarded the Bronze Star for his efforts in the care of combat-wounded soldiers and Afghanistan citizens. He has experience treating young athletes with ligamentous injuries, patients with fractures, and older individuals requiring joint replacement surgeries. He earned his undergraduate degree from Richard Stockton College of New Jersey and his medical degree from Philadelphia College of Osteopathic Medicine.