Have you been recently diagnosed with a rotor cuff injury? Doctors perform a physical exam, shoulder X-rays, and MRI to confirm such a diagnosis. Based on their findings, they might recommend rotator cuff repair surgery, especially if a tendon is torn.
Nonsurgical methods cannot repair tendon tears, which makes surgery inevitable. There are multiple surgical techniques used for such injuries, depending on the severity of the tear. The recovery process is of tremendous importance following the surgical procedure.
Here is everything you need to know about rotator cuff repair.
What is the Rotator Cuff?
The rotator cuff consists of multiple muscles and tendons whose job is to link the humerus to the shoulder blades. It also makes sure the upper arm bone stays in place in the shoulder socket. The rotator cuff includes four muscles, the infraspinatus, the supraspinatus, the subscapularis, and the teres minor. Check out this description of the shoulder human anatomy.
Moreover, each of these muscles makes a connection with the arm bone with a tendon. This part of the shoulder is of great importance, as it allows individuals to lift their arms. Nevertheless, a rotator cuff injury, usually a tear, can occur suddenly due to a fall or develop gradually as a result of doing repetitive activities. If you happen to injure your rotator cuff, there might be a need for a surgical procedure to repair the torn tendon or muscle. The role of surgery is to restore the flexibility and function of the shoulder, as well as alleviate the pain.
The rotator cuff is usually injured through poor movement or deterioration of the muscles and tendons. Some movement patterns, such as pushing the head forward or slouching, can put it at risk. Also, as people get older, the rotator cuff undergoes irritation by calcium deposits in the shoulder area. Repetitive stress is another cause of concern, which is why swimmers, tennis players, painters, baseball pitchers, and carpenters are at greater risk of suffering from such injuries.
Furthermore, these injuries vary in severity, as tendons can be inflamed, partially torn, or fully torn. Anyhow, the pain in the shoulder area may be triggered by bursitis, a medical condition that affects the bursa, which becomes either irritated or inflamed. Regardless of the type of injury, individuals usually experience shoulder weakness, inability to move it, a limited range of motion, and overwhelming pain when trying to lift or pull something.
Also Read: Shoulder Compression Brace Review
Surgical Repair Options
When the rotator cuff is injured, there are several surgical techniques to repair the damage. While surgery isn’t always recommended, doctors offer it as an option when pain doesn’t seem to improve with nonsurgical treatments. There are numerous orthopedic specialists performing several types of rotator cuff repair surgery, depending on the injury type. A surgical procedure is required in patients whose symptoms have persisted between six and twelve months.
In addition, surgery is the best method in patients with large tears exceeding three centimeters. Also, such a procedure is recommended to individuals suffering from significant shoulder weakness and a loss of function. The same goes for patients whose tendon tear has been caused by an acute injury, which happened recently.
There are three main surgical techniques that treat rotator cuff repair, which are open, all-arthroscopic, and mini-open repair. Open repair is used in cases when tendon tears are complex and large, or a tendon transfer has to be performed.
Surgeons make an incision of several centimeters over the shoulder and detach the deltoid to access the tendon and see better. When this procedure is performed, the surgeon usually performs bone spur removal from the acromion. This technique was first used for the repair of torn rotor cuffs, but new, less invasive techniques have been invented since then.
For instance, the all-arthroscopic repair is the complete opposite in terms of invasiveness, as this procedure is minimally invasive. Instead of making a large incision, surgeons make several small incisions, which fit the surgical instruments. Doctors insert a small camera into the shoulder joint, which displays pictures on a TV screen, and they use these images to guide the instruments.
Last but not least, mini-open repair relies on new technology and small instruments to repair a rotator cuff through an incision between three and five centimeters. This surgical technique makes use of arthroscopy for assessing and treating damage to other joint structures, such as bone spurs. By removing these arthroscopically, there is no need for doctors to detach the deltoid muscle. Go to this URL, to learn about the anatomy, function, and treatment of the deltoid muscle.
After the arthroscopic part of the surgical process is finished, the surgeon performs rotator cuff repair through the open incision. While repairing the tendon, he/she looks at the shoulder structures directly, not on a monitor.
The recovery process is essential after such a surgical procedure, consisting of pain management and rehabilitation. Pain is a normal part of healing, which shouldn’t surprise you after the surgery. You will be prescribed some medications for pain management, like NSAIDs, local anesthetics, opioids, etc. While opioids are incredibly effective in pain management, they are addictive and narcotic.
Rehabilitation is vital for getting back to your normal activities. Physical therapy after the surgery progresses in three stages, immobilization, passive exercise, and active exercise. Patients are required to use a sling during the first four to six weeks to keep the arm from moving. Passive exercises are also performed in this period to strengthen the muscles around the arm and start moving the arm in different positions.
After the initial recovery period of four-six weeks, physical therapy reaches the stage of active exercise. It means you will no longer require assistance from your therapist to perform the exercises. Full recovery is expected after four to six months. The commitment of patients to rehabilitation is the core of recovery.
To Sum Up
Nowadays, technology has made rotator cuff surgery options less invasive than in the past!