The Most Common Shoulder Problems & How to Treat Them [Dr. Dressander]

My name is Jeff Dressander. I'm an orthopedic surgeon, and I enjoy orthopedics because it allows me to treat bones and joints for patients of all ages. 

What is a rotator cuff?

A common reason for patients to come to see us is for injuries to what we call the rotator cuff. So the rotator cuff surrounds a shoulder joint, provides stability and movement in many directions for the shoulder. 

What causes rotator cuff injuries?

There are several main ways somebody can have a problem with the rotator cuff. The first is an injury like a fall or sports injury, which results in a traumatic tearing of the rotator cuff. So another way people can injure their cuff is from use and abuse over time, commonly seen in people who do a lot of repetitive activities with their arms, such as working in a factory setting. Working overhead a lot is a very common story I hear when people are coming in complaining of shoulder pain.

What are symptoms of rotator cuff injuries?

The most common complaint I hear from somebody with a rotator cuff problem is pain. Pain could be occurring at night that interrupts their sleep. Pain with activities such as lifting or reaching overhead and just pain with resting and sitting doing nothing at all can be painful sometimes. 

How do you diagnose a rotator cuff injury?

First, we try to get a story from the patient that gives us a clue to maybe how their shoulder was positioned when they were injured. If they can't point to a specific injury, I ask them about the activities they do at work and for recreation because that can often provide clues to what's been causing their pain as well.

What steps are taken before surgery?

Surgery is always the last resort for these issues. Things we try to get people back to doing what they need to do for work and other things. Number one is medication that can be taken by mouth. We can also inject medicine around the rotator cuff which can help lower their pain, followed by some physical therapy, rehabilitation to help maintain muscle strength and flexibility.

When is surgery the best treatment?

When is surgery needed for a rotator cuff injury? If there's been a single traumatic injury that's resulted in a very large tear of the muscle, we know that those need to be repaired quickly to preserve muscle function. However, if it's a situation that's been building up over time, the patient usually tells me when it's time to have surgery, meaning that the pain has reached a level that's really interfering with what they like to do day to day and they just can't put up with it anymore.

How is rotator cuff surgery performed?

For patients who go on to need surgery for the rotator cuff injuries, we're able to fix almost all of them arthroscopically or with a minimally invasive approach, meaning we just make small poke holes around the shoulder, use a small camera and other small tools to reattach the muscle back to the bone where it tore from. This allows patients a quicker recovery, less scarring, and we're able to get them back to doing the things they want to do quicker.

What can patients expect during recovery?

Recovery from a rotator cuff repair can take several months. The first phase of that is getting patients' motion back in the shoulder and then a gradual strengthening program that can take up to six months in most patients. 

When will patients notice less pain?

Good thing is the pain relief is realized sooner than the total recovery time, but that's the biggest advantage of rotator cuff repair, is pain reduction that they experience usually within the first two to three weeks after the operation. 

Why is post-surgery therapy important?

The therapy is as important as the actual surgery itself, because without it, people won't regain the normal motion of the joint, they won't have the strength that they need, and after undergoing a big operation like that, not putting the time with the rehab can mean you're not going to have as good a result afterwards. 

Why would you recommend rotator cuff surgery at Brookings Health System?

At Brookings, we have access to the latest equipment, the latest techniques to help people get back to using their shoulders like they want to.