The rotator cuff is a group of muscles and tendons that surround the shoulder joint, keeping the head of your upper arm bone firmly within the shallow socket of the shoulder which creates the ability to lift your arm. Just like hips and knees, arthritis and rotator cuff tears are quite common as one ages, with the majority of people developing arthritis after the age of 60 and rotator cuff tears after the age of 40. The tendons and muscles naturally degenerate over the years, which means they may tear entirely during a strenuous activity as a person ages. In younger people, the rotator cuff can tear following a fall or other traumatic injury.
The most common cause of rotator cuff tears is excessive stress, most often affecting people who repeatedly perform overhead motions in their jobs or while playing sports. Examples include painters, carpenters and athletes. Many people recover from rotator cuff damage with physical therapy exercises that improve flexibility and strength of the muscles surrounding the shoulder joint.
Depending on the severity and the specifics of your case, some non-invasive treatment options could restore the functionality of your shoulder. If you are a candidate for non-surgical treatment options, your doctor will recommend any combination of rest, reduced or ceased activity level, pain relief medications and/or physical therapy. If this treatment plan does not provide the level of pain relief you desire, you may require an injection of cortisone, a highly effective anti-inflammatory medication. If your pain does not improve with nonsurgical methods, your doctor will likely suggest surgery.
Surgery to repair a torn rotator cuff most often involves re-attaching the tendon to the head of humerus (upper arm bone). A partial tear, however, may need only a trimming or smoothing procedure called a debridement. A complete tear is repaired by stitching the tendon back to its original site on the humerus.
SURGICAL REPAIR OPTIONS
Recent advancements in surgical techniques for rotator cuff repair include less invasive procedures. Many surgical repairs can be done on an outpatient basis and do not require you to stay overnight in the hospital. Your orthopedic surgeon will discuss with you the best procedure to meet your individual health needs.
The three techniques most commonly used for rotator cuff repair include traditional open repair, arthroscopic repair and mini-open repair. In the end, the goal for any of these options is pain relief, strength improvement and increase in mobility.
1. Open Repair: This technique involves an open surgical incision several centimeters long over the shoulder. The surgeon separates the shoulder muscle (deltoid) to better see and gain access to the torn tendon. During an open rotator cuff repair, the surgeon may also remove bone spurs (osteophytes), which are a sign of osteoarthritis and can sometimes cause shoulder pain or affect shoulder joint function. An open repair may be a good option if the tear is large or complex or if additional reconstruction is necessary.
2. All-Arthroscopic Repair: During arthroscopy, your surgeon inserts a small camera, called an arthroscope, into your shoulder joint. Your surgeon uses the images displayed on a television screen to guide miniature surgical instruments. Since the arthroscope and surgical instruments are thin, your surgeon can use very small incisions rather than the larger incision needed for standard, open surgery.
The primary advantage of all-arthroscopic repair is that it allows a surgeon “global” access to the rotator cuff and tear for adequate cuff evaluation, repair and fixation to bone. The procedure is usually an outpatient procedure and is the least invasive method to repair a torn rotator cuff.
3. Mini-Open Repair: The mini-open repair uses newer technology and instruments to perform a repair through a small incision, typically 3 to 5 cm long. This surgical procedure is used to inspect and reattach torn tendons in the rotator cuff. The initial part of the surgery is performed arthroscopically through small tubes but open surgery may be needed to repair large tears. Once the arthroscopic portion of the procedure is completed, the surgeon repairs the rotator cuff through the mini-open incision. During the tendon repair, the surgeon views the shoulder structures directly, rather than through the video monitor.
RECOVERY
After any surgery, it is expected that you will feel pain as a natural part of the healing process. Your medical team will do everything they can to reduce your pain and help you recover from surgery faster.
Prescription medications are often advised for short-term pain relief after surgery. Your doctor may use a combination of opioids, non-steroidal anti-inflammatory drugs (NSAIDs) and local anesthetics to provide some pain relief.
Opioids help relieve pain after surgery, but they are a narcotic and can be addictive, so it is important to use opioids only as directed by your doctor and to be aware of the potential for opioid dependency and overdose. As soon as your pain begins to improve, stop taking opioids. Talk to your doctor if your pain has not begun to improve within a few weeks after your surgery.
REHABILITATION
A physical therapy program plays a vital role in getting you back to your daily activities and will help you regain shoulder strength and motion. You can realistically expect a complete recovery to take several months and understand that your commitment to rehabilitation is key to a successful outcome. Most patients have a functional range of motion and adequate strength by 4 to 6 months following surgery.
Immobilization: After surgery, your repair needs to be protected while the tendon heals. You will most likely use a sling to keep your arm from moving and your doctor will advise that you avoid using your arm for the first 4 to 6 weeks.
Passive Exercise: Typically within the first 4 to 6 weeks after surgery, you will begin a program of passive exercise with a physical therapist. Your therapist supports your arm and moves it in different positions to improve range of motion in your shoulder.
Active Exercise: After 4 to 6 weeks, you will progress to doing active exercises without the help of your therapist. Moving your muscles on your own will gradually increase your strength and improve your arm control. At 8 to 12 weeks, your therapist will start you on a strengthening exercise program.
OUTCOME
The majority of patients report improved shoulder strength and less pain after surgery for a torn rotator cuff. Each surgical repair technique (open, mini-open and arthroscopic) has similar results reported by patients in terms of pain relief, improvement in strength and function and patient satisfaction.
To learn more about rotator cuff tears, including your options for prevention and treatment, speaking with an orthopedic specialist is your best choice. Our skilled and experienced orthopedic surgeons will perform a thorough examination of your shoulder, analyze x-rays and conduct physical tests.
To learn more about the procedure or to schedule an appointment with one of our rotator cuff repair specialists, call us at 800-698-1280.
