In my nearly twenty-five years of orthopaedic practice, almost every patient referred to me with shoulder pain comes to my office with some form of fear about having a torn rotator cuff. Thankfully, not every aching shoulder is caused by a torn rotator cuff (RC), but it is common for the presence of a torn rotator cuff to cause pain.
While it’s true that having the dreaded “tear” is often a major problem, it is also true that modern solutions for repairing RC tears have been immensely improved by advances in technology and medical science. Over the last decade, with the emergence of arthroscopic surgery, repairing a RC tear with a fiber optic telescope, through very small incisions, has become almost a daily occurrence in my practice.
The two most common types of RC tears are degenerative (overuse) and traumatic (injury) type tears. Some folks are thought to be prone to developing these tears due to variations in their shoulder anatomy. In other words, genetics or heredity may play a role.
Tears can range from small, partial thickness tears all the way up to massive, irreparable tears. Partial tears are like frayed denim over the knees of your favorite blue jeans that are starting to wear out. Once you start to see the skin over your kneecap, however, then that’s a “full” thickness tear, a more serious problem. Most tears start out small and get larger, or propagate, over time. At some point, a RC tear will usually start to cause problems for its “owner.”
Common complaints attributed to a torn RC are pain in the shoulder or upper arm, especially at night and weakness in the arm, especially with reaching or overhead activities. I can often detect the signs of a RC tear when I examine a patient in my office, but confirming tests are also necessary to understand the size and pattern of the tear. The tests I most commonly order are:
- MRI scan
- Diagnostic ultrasound
If a RC tear is found, depending on a number of factors including the patient’s age, activity level, and overall health status, then a surgical repair of the RC tear may be the best option for treatment. After all, most complete tears of the RC do not simply heal themselves, and often the problem just becomes worse over time. There is no sense in allowing a smaller, reparable type tear to progress to a massive, irreparable tear when it could have been more easily fixed early on. By and large, cortisone injections into the shoulder simply help to cover up the problem of a torn RC and do not help to solve the underlying mechanical problem caused by a torn RC tendon.
Rotator Cuff Repair Surgery
This surgery, in my practice, is exclusively performed using state of the art arthroscopic surgery techniques. This is done as an outpatient procedure with no need for an overnight stay at the outpatient surgery facility. The surgery is performed under general anesthesia with the simultaneous use of a nerve block which keeps the shoulder and arm numb for many hours after the surgery is completed. The entire surgery is performed through 4 to 6 quarter-inch incisions around the shoulder. The surgery itself takes about an hour to perform and a shoulder immobilizer is applied to the patient before transfer to the recovery room.
After the Surgery
Strong pain medicine is prescribed for several days to several weeks. Physical therapy is initiated the same week as the surgery. Patients must wear a shoulder immobilizer full time, except to bathe, for the first five weeks following surgery. At five weeks post-surgery, or thereabout, a weaning protocol is initiated for eliminating the immobilizer/arm sling and active use of the arm is encouraged. Once good active motion is achieved, strengthening exercises are initiated. The total duration of recovery from surgery to full release back to normal activity is 3-4 months. Even after release from care, patients commonly experience improvement in shoulder function for up to a year following RC repair.
Surgery is never without some form of risk. Patient satisfaction with arthroscopic RC repair is greater than 90% in my experience. While uncommon, patients do sometimes develop significant problems which require follow-up surgery. This occurs primarily with post-surgical stiffness, known as frozen shoulder, or when the repair fails to completely heal properly.
Since 2001, arthroscopic RC repair has been performed by me and the other surgeons here at Tri-State Orthopaedic Surgeons. Literally, thousands of your family members, friends, co-workers and neighbors have benefited from this wonderful technological breakthrough. So next time you think, “Wow, my shoulder is really hurting,” your next thought should be, “Well, I hope I don’t have a rotator cuff tear, but if I do, I know the surgeons to fix it.”