Long-time Kansas City Royals fans will remember the promising career of pitcher Steve Busby. Just 23 when he threw the Royal’s first no-hitter in 1973, he was even better the next 2 years, pitching another no-hitter and appearing in 2 straight All Star Games.
But that fast start came with a price. Over his first 3 seasons, Busby threw more than 791 innings, often throwing 100 pitches a game. By 1976, he was diagnosed with a tear in his rotator cuff and became the first athlete to receive the new, revolutionary surgery.
These days, rotator cuff surgery is not reserved for just baseball pitchers and quarterbacks. Anyone who performs repetitive overhead motions, like painters, construction workers and folks on an assembly line are at risk for a tear in their rotator cuff.
We asked Kenneth Teter, M.D., orthopedic surgeon at The University of Kansas Health System St. Francis Campus, to explain some of the common injuries and treatments involving a patient’s rotator cuff.
The rotator cuff is important in raising the arm overhead and rotating the arm. It is a group of 4 muscles and tendons that enclose the shoulder joint. They are important in moving the shoulder and keeping the ball portion of the shoulder aligned with the socket portion of the shoulder.
Most rotator cuff tears are due to gradual wear and not a specific injury. Rotator cuff tears can also result from forceful overhead lifting or from a fall. The rotator cuff tends to start fraying in most people after the age of 50. For baseball pitchers, the fraying process is accelerated over many years. Just like a rope can fray, the fraying may eventually lead to the tendon becoming disrupted from the shoulder bone. Rotator cuff tears tend to enlarge over time and can even result in the ball portion of the shoulder riding high in the socket.
The most common symptoms of a rotator cuff problem are pain with overhead activities and pain when lying on the affected side. The pain is most commonly on the side and front of the shoulder but can also be in the back of the shoulder and it can radiate to the elbow. Rotator cuff tears will often disrupt the patient’s sleeping.
Not all rotator cuff tears cause significant symptoms. Studies have shown that 54% of people over the age of 60 have a partial or complete rotator cuff tear and have no significant symptoms. An ultrasound done on people with no shoulder symptoms have shown complete tears in 13% of people aged 50-59, 20% of people aged 60-69, 31% of people aged 70-79 and 51% of people over the age of 80. Thus, it takes even an experienced surgeon time to sort out what is the source of a patient's shoulder pain.
Stretching or strengthening exercises aren't able to prevent the fraying and tearing of the rotator cuff associated with aging. However, physical therapy and exercising can be very helpful in alleviating the pain and functional problems associated with rotator cuff problems. Exercising with rotator cuff problems should be supervised by a physical therapist so as not to aggravate the condition.
Non-operative treatment of partial or full rotator cuff tears will usually decrease the pain and improve the function. Physical therapy, avoiding overhead use of the arm and injections all are helpful, but these improvements are sometimes only partial and temporary. Most active people with full thickness tears will have the best long-term results with a successful surgical repair. If people in their 50s and early 60s have a neglected rotator cuff tear, they can develop severe changes over the years. This will necessitate a special type of shoulder replacement called a reverse shoulder arthroplasty.
In most cases, the rotator cuff tears occur near its attachment to the bone. In surgery, the tendon is reattached to the bone with devices called suture anchors. This is typically done through small incisions arthroscopically guided. The biceps tendon, which is not part of the rotator cuff but next to it, can also be frayed or torn and is addressed at the same time.
Full recovery from rotator cuff surgery takes a long time. While healing, a repaired rotator cuff needs to be protected. The period before the patient is allowed to raise their arm overhead or begin any strengthening is frequently 2-3 months. Motion is encouraged early, but under the supervision of a physical therapist. People who have jobs that require pushing, pulling or overhead work may require 4-6 months before returning to their full work duties.
Dr. Teter and the Orthopedics and Sports Medicine team at St. Francis Campus use advanced techniques and technology to treat a wide range of orthopedic conditions. If you think you have a rotator cuff injury or an arm or leg injury, visit our web page or call one of our orthopedic offices to make an appointment: