How Can I Deal With Rotator Cuff Injuries If I’m Over 45?

The short answer from an orthopaedic sports medicine surgeon
man with rotator cuff injury

Q: How can I deal with rotator cuff injuries if I’m over 45?

A: People older than age 45 are increasingly at risk for this injury. The cause of a partial or full rotator cuff tear is typically multifactorial and the major factors are age-related degenerative changes of the tendon and increasing/changing loads to the tendon. Certainly, traumas such as falls or shoulder dislocations can lead to tears.

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The rotator cuff is only about 5 millimeters thick, so an injury at the level of slipping on ice can do it. Such injuries cause increased pain and prompt people to go to the doctor, although usually after one week, people will simply be sent home with anti-inflammatory medication.

Usually, when people have shoulder pain, it’s just tendonitis and doesn’t necessarily indicate a tear in the rotator cuff. Tendonitis is more common than a rotator cuff injury and comes from wear and tear. There’s only a certain amount of room for the rotator cuff to fit, and it’s just rubbed underneath and gets inflamed.

Most often, tendonitis is due to activities like common yard work — snow shoveling, leaf raking or spring yard cleanup — that requires repetitive motions the body doesn’t otherwise often make. For tendonitis, we usually recommend a focused, six-month therapy program. This usually gives significant relief.  

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Physicians typically will order magnetic resonance imaging (MRI) for those patients with persistent pain that has failed to improve over 4 to 6 weeks. When a tear is found, it’s often quite a bit more than 4 to 6 weeks old. It is helpful to think of the rotator cuff tendon as a “rope of a thousand strands.” Some of these strands may have already been torn prior to an injury event. There are multiple considerations prior to deciding on surgical repair, including but not limited to the amount of “strands” torn, the location of the “strands” and the quality of the “strands”.

Shoulder injuries take time to heal, even if the rotator cuff isn’t torn. You may wonder: Is ice or heat better for the rotator cuff? We recommend using anti-inflammatories and ice.

— Orthopaedic sports medicine surgeon Michael J. Scarcella, MD

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