[Sportschosun, Jang Jong-ho] Middle-aged and older adults often assume that shoulder pain is just muscle soreness or frozen shoulder.
However, some conditions can worsen if treatment is delayed, so caution is needed.
A typical example is a rotator cuff tear.
A rotator cuff tear can worsen over time. If treatment is delayed, a partial tear can progress to a full-thickness tear, and a full-thickness tear can develop into a massive tear.
As the population ages, the number of patients with rotator cuff tears continues to rise.
According to data from the Health Insurance Review & Assessment Service (HIRA), the number of patients treated for rotator cuff syndrome rose from about 550,000 in 2014 to about 890,000 in 2023. Many people mistake it for simple shoulder pain and miss the right time for treatment. Without proper care, it can lead not only to reduced shoulder function but also to a lower quality of life.
The rotator cuff is made up of four tendons — the supraspinatus, infraspinatus, subscapularis, and teres minor. It helps stabilize the shoulder joint while lifting and rotating the arm. In particular, the supraspinatus tendon passes through a narrow space beneath the acromion, making it especially vulnerable to repeated friction and pressure.
A rotator cuff tear is not simply caused by overusing the shoulder. It develops through a combination of age-related degeneration, repeated shoulder use, poor posture, and trauma. In the early stage, the tendon surface becomes rough and tiny cracks appear. With repetition, however, the tear can progress to a full-thickness rupture.
Treatment depends on the extent of the tear and the patient’s condition. For early inflammation or small partial tears, conservative treatment such as medication, injections, physical therapy, and rehabilitation exercises is usually tried first. But if there is a full-thickness tear or severe loss of function, arthroscopic rotator cuff repair may be considered.
Thanks to advances in arthroscopic surgery, even larger tears can now be repaired more successfully than in the past. Still, in elderly patients with massive rotator cuff tears, severe muscle atrophy, and fatty degeneration, repair alone may be difficult.
For these patients, shoulder replacement surgery is drawing attention as an effective treatment option.
Park Joon-soo, head of Orthopedic Surgery at Incheon Sejong General Hospital, said, "When people hear about joint replacement, they usually think first of the knee or hip, but it can also be applied to the shoulder." He added, "In particular, when a rotator cuff tear has progressed for a long time and functional recovery is difficult, joint replacement surgery is performed."
Shoulder replacement surgery is not simply an operation that replaces a damaged joint with an artificial one. Its core principle is to shift the center of rotation of the arm downward and inward, increase the tension of the deltoid muscle, and allow the deltoid to lift the arm in place of the damaged rotator cuff.
It is especially effective for patients with pseudoparalysis caused by massive rotator cuff tears, who can barely raise their arms. Patients who had been unable to move their arms as if they had nerve damage can lift them again after surgery, restoring shoulder stability and function.
Recent advances in materials engineering and surgical techniques have also reduced complications such as dislocation and bone resorption. In addition, surgeons can now design a prosthesis tailored to each patient before surgery, making personalized procedures possible.
Prostheses with a variety of sizes and biomechanical properties have also been developed, allowing surgery to be adapted to each patient’s physical characteristics while preserving as much bone as possible. Navigation systems and robotic technology are also being introduced to help plan more precise implant placement.
Park Joon-soo said, "A rotator cuff tear should not be left untreated as a simple sign of aging. It is important to receive an accurate diagnosis and treatment at the right time." He added, "If the pain begins to affect daily life, you should actively seek medical care."
Jang Jong-ho, bellho@sportschosun.com
