Rotator Cuff Tear
Click Here to listen to Dr. Gerald Williams discuss Rotator Cuff Injuries.
Unfortunately, a rotator cuff tear is not an uncommon problem and is a frequent cause of disability and pain in the adult population. The rotator cuff is a group of four muscles and their tendons that wrap around to form a “cuff” over the upper end of the arm. The rotator cuff helps guide the shoulder through many motions by allowing lift and rotation to the arm while stabilizing the ball of the shoulder within the socket.
A rotator cuff tear occurs when there is a tear or injury to one of the rotator cuff tendons.
Nonoperative Treatment
Once a rotator cuff diagnosis has been determined, your orthopaedic physician will prescribe the most effective treatment. In most cases, nonoperative treatment can provide sufficient pain relief while improving the shoulder function. However, if the tear is a result of an acute injury and is associated with inability to raise the arm or weakness, early surgery should be considered.
Initial treatment options include:
*Simple rest and reduction of any overhead activity
*Placing the arm in a sling
*Anti-inflammatory medication
*Steroid injection
*Physical therapy and strengthening exercises
In most cases, it usually takes a few weeks to a few months to effectively restore the strength and mobility of the patient’s shoulder.
Surgical Treatment
If the patient does not respond to nonoperative treatment, the orthopaedic physician may then prescribe surgery. Surgery may also be an option if the tear is acute and extremely painful, if it is the dominant arm of an athlete or worker, or if maximum strength is needed for daily occupational activities. Early surgery is indicated if the tear was caused by a significant injury and is associated with weakness or inability to raise the arm.
The type of surgery performed is dependent on the shape, size, and location of the tear. A partial tear may only require a trimming or smoothing procedure called a “debridement.” A complete tear that occurs within the substance of the tendon is repaired by suturing the two sides of the tendon. However, if the tendon is completely torn away from its insertion on the humerus bone, it can be repaired directly to the bone.
Most surgical procedures can be performed on an outpatient basis. There are three general approaches available for surgical repair:
*Arthroscopic repair. Through the use of a tiny fiber optic scope and other small instruments inserted through small puncture wounds, your physician can repair the damaged tendon under video control. This eliminates the need for a large, open incision.
*Mini-open repair. Advanced instrumentation and techniques now allow orthopaedic surgeons to perform complete rotator cuff repair procedures through a four to six centimeter incision.
*Open surgical repair. If the rotator cuff tear is large or complex in nature or if additional reconstruction (such as a tendon transfer) has to be performed, then a traditional open surgical incision is required. In some extreme cases, where arthritis has developed, shoulder replacement surgery may be required.
Your Rothman Institute orthopaedic surgeon will be able to recommend which technique is best for you. |
