Rotator Cuff Repair
Rotator cuff tears are one of the most common shoulder problems. The rotator cuff is made up of four different small muscles (supraspinatus, infraspinatus, subscapularis, teres minor) that help move your arm and shoulder in space, especially with reaching or lifting overhead. The tendon portion of the muscle, where it attaches to the lateral humerus (the ball of the ball and socket of the shoulder), can develop tears. These tears come in many shapes and sizes, are often from overuse, and can come from specific injury as well (falling, lifting, etc). The tear can be a partial tear or a complete tear. Symptoms are usually pain in the lateral (outside) shoulder often radiating down the arm, night pain waking you up, and weakness.
Treatment of rotator cuff tears is a spectrum that spans from physical therapy to injections to surgical repair. The specific treatment for your shoulder depends on many factors, including tear size, age of the tear, patient age, treatments tried, etc. The goal of all treatment is to preserve your rotator cuff from further damage, repair damaged tissue when possible, and help your pain, weakness, and function.
Surgical treatment for a rotator cuff tear is usually done arthroscopically (through a “scope” with small incisions around the shoulder for a camera and instruments). Anchors are put into the bone of the humerus and have sutures attached. These sutures are then passed through the edge of the torn tendon and tied, reducing and holding the tendon to the bone where it had torn away. These sutures and anchors then hold the tendon in place while the body biologically reattaches and heals the rotator cuff. This is a long process, necessitating a long course of physical therapy and limitations on activity, usually months, while it heals. The tendon itself is often unhealthy from years of damage, and part of the success of the surgery depends on the ability of the body to heal this poor tissue.
After surgery, your doctor will give specific instructions to you and your therapist detailing when to start range of motion (ROM) exercises, when to stop using your sling, when active motion of the arm is allowed, etc. All of this is variable and depends on your specific repair. Usually, when motion is started, it is called passive ROM. This means that the arm is taken through an arc of motion under the power of your other arm or a physical therapist moving it. The muscles of the rotator cuff cannot be doing this motion initially, or they can pull the repair loose.
This progresses through active assisted and then active ROM and strengthening. Following your doctor and therapist’s instructions is critical to the success of your surgery. Long term, it is important for the health of both of your shoulders to maintain a good rotator cuff program to keep your muscles strong and healthy and avoid future damage.
To find out if rotator cuff repair is right for you, schedule an appointment with one of our joint preservation surgeons by calling 888-660-2663 or complete the appointment request box.