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
- 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
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
- 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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