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Shoulder Pain Relief: Common Rotator Cuff Injuries & Treatment Options​ - Andrew Beharrie, MD​ - Fairlawn Library - 3.3.2021

If you are experiencing shoulder pain, a rotator cuff tear could be the issue. Learn about how, and why, rotator cuff tears happen, how the condition and severity is diagnosed, and the non-surgical and surgical treatment options available.

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Shoulder Pain Relief –
Common Rotator Cuff Injuries & Treatment Options
Andrew Beharrie, MD
Orthopedic Surgeon
Summit Medical Group
March 3, 2021
My Background
BS in Electrical and Biomedical Engineering at MIT
Medical School: Harvard Medical School
Orthopaedic Residency: University of Pennsylvania
Fellowship in Sports Medicine: Lenox Hill Hospital
Summit CityMD
N E W Y O R K
N E W J E R S E Y
• 7.4 million
annual patient
encounters
• 1,600+ providers
• 80+ specialties
• 215+ locations
• New Jersey
• New York
• Oregon
Overview
Common Causes of Shoulder Pain
• Shoulder Bursitis / Impingement Syndrome
• Rotator Cuff Tendon Tear
• Frozen Shoulder
• Shoulder Arthritis
Anatomy
Ball and Socket Joint
• Proximal Humerus (Ball)
• Glenoid (Socket)
• Acromion (Roof)
• Inherently Unstable Joint
• Analogous to golf ball on a T
• Only 1/3 of the humerus is in
contact with the glenoid at
any given motion
• Relies on muscular and
capsular attachments for
stability
Anatomy
Anatomy
4 Rotator cuff muscles
• Subscapularis
• Supraspinatus
• Infraspinatus
• Teres Minor
• Responsible for keeping the proximal
humerus centered within the glenoid
Anatomy
Acromion Morphology
• Type I – Flat
• Type II – Curved
• Type III - Hooked
Anatomy
Subacromial Bursa
• Lubricates underlying
rotator cuff tendons
• Reduces friction
between tissues
Impingement
Syndrome
Impingement
Syndrome
Presentation
• Pain along upper arm
• Worse with overhead
motion
• Night Pain
Impingement
Syndrome
Biomechanics
• Compression of underlying bursa/cuff
• Impingement occurs between 60 - 120 deg of flexion
Impingement
Syndrome
Impingement
Syndrome
Physical Exam
• Pain with forward
flexion (>90 deg)
• Pain with abduction and
internal rotation
• Pain with lowering of
the arm from flexed
position
• Pain with reaching out
Impingement
Syndrome
Imaging
• X-rays
• MRI
Impingement
Syndrome
Treatment
• NSAIDS
• Home exercises
• Physical therapy
• Cortisone Injections
• Up to 3 per year
Impingement
Syndrome
Surgery
• Arthroscopic – minimally
invasive
• Approximately 30-45 min
• 3 small incisions around the
shoulder
• Goal is to remove spur
causing impingement
Impingement
Syndrome
Post op Care
• Sling for 10 days
• Begin ROM exercises at
home
• Formal PT at 6 weeks
• Back to most activities at 3
months
Rotator Cuff Tears
More common over the age of 40
Most are from degenerative “wear and tear”
Trauma
Inflammatory disease – rheumatoid arthritis
Presentation
• Pain along upper arm
• Worse with overhead
motion
• Night Pain
• WEAKNESS
Rotator Cuff Tears
Physical Exam
• Similar to impingement syndrome
• Weakness
• Resisted forward flexion
• Resisted external rotation
• Weakness in internal
rotation
Rotator Cuff Tears
Imaging
• X-rays
• MRI
Rotator Cuff Tears
Non-operative treatment
• Partial thickness tears
• Small (< 2cm) full thickness tears without
atrophy
• Chronic large retracted tears with muscle
atrophy
• Medical issues
Rotator Cuff Tears
Operative treatment
• Full thickness tears > 2cm
• Failure of non-operative treatment for 3-
4 months
• Acute tear in young patient / laborer
Rotator Cuff Tears
Arthroscopic repair
• Minimally invasive
• Can see the entire shoulder and
rotator cuff
• Maintenance of deltoid attachment
• Decreased risk for infection
• Decreased patient discomfort
Rotator Cuff Tears
Shoulder Pain Relief: Common Rotator Cuff Injuries & Treatment Options​ - Andrew Beharrie, MD​ - Fairlawn Library - 3.3.2021
Post Op Regimen
• Sling for 6 weeks
• Elbow and wrist motion
only
• Begin PT at 6 weeks
• ROM for 6 weeks, then
strengthening for 6 weeks.
• Full recovery by about 6
months
Rotator Cuff Tears
Chronic Rotator Cuff Tears  Osteoarthritis
Osteoarthritis
Presentation
• Loss of motion / Stiffness
• Pain with overhead activities
• Localized deep within the
joint
• Night pain
Presentation
• Pain
• Weakness (pseudo paralysis)
• Inability to raise the arm
Chronic Rotator Cuff Tear
Chronic Rotator Cuff Tear
X-rays
• Normal
• Superior migration of the proximal humerus
with minimal or no arthritis
• Superior migration of the proximal humerus
with arthritis
Treatment
• Non operative
• Injections
• NSAIDS
• Activity modification
• Physical therapy
• Operative
• Reverse total shoulder arthroplasty
Treatment for Rotator Cuff Arthritis
Indications
• Torn or insufficient rotator cuff tendons
with loss of function
•  superior migration of humerus
•  arthropathy
• Revision surgery
• Proximal humerus fracture not amenable to
plate fixation
Reverse Total Shoulder Arthroplasty
Reverse Total Shoulder Arthroplasty
Surgery
• One night stay
• Nerve block generally lasts 16-
18 hours
• Strict post op regimen
Post op regimen
• Sling for 3-4 weeks
• Elbow and wrist motion only
• Begin PT at 3-4 weeks
• Good function by 2-3 months
• Improvement up to 1 year
Reverse Total Shoulder Arthroplasty
Thank You!!
Andrew Beharrie, MD
Summit Medical Group Orthopedics
499 Route 17 South
Paramus, NJ 07652
Office phone: 973-437-2615
Website: smgortho.com

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