An Overview of Rotator Cuff Pain in Elderly Patients and Surgical Treatment
As individuals age, it is important for them to remain active for overall physical and mental health. Popular activities in older adults include golf, tennis, skiing and biking, all of which not only provide excellent forms of physical activity but also serve as a great way for seniors to stay engaged socially. Unfortunately, shoulder pain in the elderly population is quite common and it can be associated with these activities. The most common cause of pain is a partial or complete tear of the rotator cuff. The rotator cuff is a series of tendons that stabilize, support, and move the shoulder. Rotator cuff tears in senior athletes typically occur from progressive age-related degeneration as the body naturally ages. They may also occur traumatic injuries such as a fall on the outstretched arm. When a tear occurs, surgery may be recommended with arthroscopic rotator cuff repair, in order to restore full function to the affected shoulder joint and to relieve pain and discomfort. It is important to note that rotator cuff repair outcomes in the older population vary from one patient to the next, so selecting a highly skilled shoulder surgeon experienced in these cases is always best. Dr. Millett has had an interest in this topic and has repaired many patients into their 60’s, 70’s and 80’s who want to remain active and pain free.
Rotator Cuff Tears in Senior Athletes
The human shoulder is held in its socket by an important structure known as the rotator cuff. The rotator cuff is a group of four muscle-tendon units that form a tendon around the upper part of the humerus (upper arm bone). The rotator cuff attaches the humerus to the shoulder blade and plays an important role in stabilizing, lifting and rotating the arm.
When one or more of the rotator cuff tendons become torn from an acute traumatic injury or from age-related degeneration, the tendon is no longer fully attached to the bone and this leads to pain and functional limitations. Night pain is a particularly commom complaiont. Rotator cuff tears are common causes of shoulder pain in elderly patients, and can be either partial or complete tears.
- Partial (incomplete) tear- the tendon is damaged but not completely severed
- Full-thickness (complete) tear- the tendon is completely severed from the bone
Contrary to popular thinking, individuals can sometimes maintain preserved function with the ability to lift the arm, even with a full rotator cuff tear. It is important to have shoulder pain evaluated by a specialist so as not to miss an opportunity for appropriate treatment.
There are two main causes of rotator cuff tears in senior athletes – acute injury and degeneration.
- Acute tear- This type of tear occurs when the shoulder and rotator cuff are placed under abnormal load or stress. Examples include:
- Biking- a tear can occur during a fall on an outstretched arm
- Tennis- a tear can occur during an awkward serve that places the arm under an extreme jerking motion
- Golf- a tear can occur during an awkward swing or one that creates a sudden impact
- Skiing- a tear can occur during a fall on an outstretched arm, from a collision, or from a direct blow to the shoulder
- Degenerative tear- In many older adults, especially senior athletes, a rotator cuff tear is the result of the wearing down of a tendon over time as the body ages. Repetitive stress placed on the shoulder joint, such as with tennis and golf, can create continued pressure on the rotator cuff. Over time, the tendons begin to fray from overuse, followed by a tear. Degenerative rotator cuff tears in senior athletes can also be caused by reduced blood supply that hinders the body’s natural healing abilities. Sometimes bone spurs may be the culprit and can gradually wear down and weaken the tendon – analogous to a rope fryaing and then breaking.
Rotator Cuff Surgery in Older Adults as an Effective Treatment Option
In order to diagnosis shoulder pain in elderly patients, a careful history and thorough physical examination are needed. If you come for a consult with Dr. Peter Millett, he will discuss the character of the pain to see if if it is present at rest or at night and to see if it is worsened with lifting and lowering the arm. He will also inquire about pain and weakness when rotating the arm, as well as the onset of your symptoms. Many of these symptoms are commonly associated with a rotator cuff tear. Xrays and and an MRI may also be used to help confirm the diagnosis.
Treatment for a rotator cuff tear in senior athletes may begin with a non-surgical approach. Common treatment options include rest, activity modification, physical therapy exercises and ibuprofen or other NSAID medications.
If non-surgical options fail, or for very active patients, a surgical approach may be necessary. Dr. Millett is a leading shoulder surgeon, and he has done research in the outcomes of rotator cuff surgery in older adults. Arthroscopic rotator cuff repair is performed in most cases to re-attach the torn tendon to the head of the humerus. There are numerous surgical techniques that Dr. Millett has helped develop in order to optimize the result. The appropriate treatment will be determined based on patient age, activity level, location of tear and tear severity.
Positive Rotator Cuff Repair Outcomes
In a recent study (New Research from Dr. Millett on the Positive Effects of Rotator Cuff Surgery in Senior Athletes over 70), Dr. Peter Millett showed that arthroscopic rotator cuff repair provides recreational senior athletes over age 70 symptom relief and full shoulder function compared to preoperative values.
Moroever, surgical repair of the rotator cuff allowed 75% of patients to return to athletic activities following surgery, such as golf, tennis, skiing and biking. None of the patients were able to participate in these activities before the surgery. Senior athletes over the age of 70 years experienced decreased pain and improved overall function after the surgical repair. Dr. Millett states, “Patients don’t want to live with pain or disability anymore, and now we know that surgery can benefit them so they don’t have to.”
To discuss rotator cuff pain in the elderly population, or a rotator cuff tear in senior athletes, please contact the office of shoulder surgeon Dr. Peter Millett to discuss rotator cuff surgery in older patients, as well as rotator cuff repair outcomes.
