Rotator Cuff Repair

The rotator cuff is a structure composed of tendons that work along with associated muscles to hold the ball at the top of the humerus in the glenoid socket and provide mobility and strength to the shoulder joint. Two fluid filled sac-like structures called bursae permit smooth gliding and decrease friction between bones, muscles, and tendons. They cushion and protect the rotator cuff. Defects in the rotator cuff can come from an acute injury (cuff tear) and or from degeneration (cuff wear). The degree to which a tendon is reparable depends on the following:

• Size Location
• Chronicity
• Mobility
• Quantity of Tendon Tissue & Bone

Understanding Rotator Cuff Tears

Rotator cuff tendons often become inflamed from overuse, aging, or a fall on an outstretched hand or another traumatic cause. People who are especially at risk for overuse are those who engage in repetitive overhead motions. Symptoms of a rotator cuff tear may develop immediately following trauma, such as a lifting injury or a fall on the affected arm, or they may develop gradually.

Some of the signs of a rotator cuff tear include the following:

• Atrophy or thinning of the muscles about the shoulder
• Pain when lifting the arm
• Pain when lowering the arm from a fully raised position
• Weakness when lifting or rotating the arm
• Crunching sensation when moving the shoulder in certain positions

Treatment for Rotator Cuff Related Pain

Treatment options for rotator cuff related pain include:

• Physical therapy
• Injections
• Surgery
• Anti-inflammatory medications (i.e. ibuprofen and naproxen)

Your doctor may recommend surgery if nonsurgical treatment has not relieved the symptoms, if the tear has just occurred and is very painful, or if maximum strength in the arm is needed for overhead work or sports. The primary reason to treat rotator cuff injuries is for pain control, as the resolution of pain is the most predictable benefit. Strength and gains in range of motion are less predictable. The type of surgery performed depends on the size, shape, and location of the tear. A partial tear may require only a trimming or smoothing procedure, called a debridement. A complete tear within the tendon's thickest part is repaired by suturing the two sides of the tendon together. If the tendon is torn away from where it inserts into the bone of the arm, it is repaired directly to bone.

Understanding the Rotator Cuff Repair Surgery Procedure

At HOI, your rotator cuff repair surgery will most likely be done on an outpatient basis. Your orthopedic surgeon will be a highly skilled specialist trained in the various shoulder surgeries and in advanced technologies such as the use of orthobiologic tissue implants that promote growth of new tissue in the body. Your surgeon will decide upon the surgical approach appropriate for you. The most often used approaches are arthroscopic repair, mini-open repair and open surgical repair. Orthobioligic implants has limited use in the shoulder currently, but are employed when necessary.

Arthroscopic rotator cuff repair has gained popularity over the past 5-10 years. This is where a small fiberoptic scope and small, pencil-sized instruments are used to give your surgeon a video image of the inside of the joint. The primary benefit of doing the procedure arthroscopically is there is less pain post operatively, however there is still pain. This technique is truly “minimally invasive.”

Mini-open repair is a newer technique in which very small instruments allow your surgeon to perform a complete rotator cuff repair through a small incision. Open surgical repair uses the traditional open surgical incision, and is sometimes employed with orthobiologic tissue implants.

After surgery, your arm will be placed in a sling, and motion limited to allow the repair to heal. Your orthopedic dedicated physical therapist will ask you to adhere to an exercise program specifically for you, which will help you regain motion and strength in the shoulder. This program will begin with passive motion and will advance to active and resistive exercises. Complete recovery may take several months. A strong commitment to rehabilitation is important to achieve a good outcome.

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