Treatment of Rotator Cuff Tears
What is it?
Arthroscopic rotator cuff repair is a method of repairing a torn rotator cuff using small incisions around the shoulder. A camera is used to visualize inside the joint and fluid is used to inflate the joint so that the surgery can be performed. Tools are used to mobilized the torn tendon edge and sew it back to the bone. When rotator cuff surgery was first performed, it was done through an open incision on the shoulder. Many surgeons still perform rotator surgery this way today. However, it is our preference to use this more minimally invasive arthroscopic approach in most patients.
Open versus Arthroscopic Repair
Although many surgeon's preference (including ours) is to perform an arthroscopic rotator cuff repair, research has shown that there are no differences between an open repair and an arthroscopic repair in terms of outcomes or recurrent tear rates. If there is no difference, than why do we prefer to perform arthroscopic repairs?
- It is minimally invasive
- Visualization of the tear is improved
- The rest of the joint can be evaluated in detail at the same time
- There is no risk for deltoid detachment (muscle detached with open repair)
- There is a lower risk of infection
What are the risks?
The surgery itself is generally very safe. There is very little blood loss and very low risk of infection. There are the general risks of anesthesia, however, usually just a light anesthetic needs to be used because most patient elect to have their arms numbed with a nerve block during the surgery. By in large, the biggest risk of surgery is that the tendon repair does not heal or retears. In most healthy younger patients with an acute rotator cuff tear, this risk is not very high. However, in older patients with chronic tears and poor tissue quality, the risk that the tendon does not heal can be substantial. Another risk of surgery is that the shoulder becomes stiff. Most of the time, this can be avoided with dedicated physical therapy.
How do I know if I have a torn rotator cuff?
The rotator cuff is a group of 4 muscles and tendons around the shoulder that helps to move and elevate your shoulder. It also functions to help stabilize the ball against the socket.
Patients with with a torn rotator cuff can have a number of different symptoms. Some patients have significant disability with pain when performing day to day activities, pain with overhead activity, and difficulty sleeping at night. Others may have minimal symptoms associated with their rotator cuff tear.
Examination by an specialist can help to determine if you have a rotator cuff tear or if your pain may be coming from elsewhere. Often times, an MRI scan is needed to evaluate the location, size, and chronicity of the tear. An MRI image of a rotator cuff tear is shown here.
What are the expected results?
In general, the vast majority of patients see improvements in their pain and function following rotator cuff repair. The ability to regain strength following a repair is dependent upon the the degree of healing the tendon undergoes following repair. Healing rates are dependent on many factors including the patient's age, the size of the tear, and the chronicity of the tear. Outcomes are also dependent on good participation in a regimented physical therapy program. It takes a dedicated effort from the patient during the post-operative period to achieve the best function out of the shoulder. Most patients can expect near normal shoulder function after completion of their healing and rehabilitation.
What is the recovery like?
Recovery from a rotator cuff tear can be a relatively difficult one and it takes a lot of hard work from the patient to achieve the best possible result from surgery. The surgery itself is done as an outpatient so you will be discharged to home the same day. You will remain in a sling at all times for several weeks after surgery (4-6 weeks). During this period sleeping can be difficult. After 6 weeks, you will begin to work to regain motion in the shoulder. After 12 weeks you will finally be able to actively move the shoulder. The prolonged period of restricted use is to protect the repair and maximize chances of healing. Progressive strengthening begins at 12 weeks. Full recovery takes 6-9 months for most people before unlimited use of the shoulder is permitted.