Rotator Cuff
The rotator cuff is the group of four muscles and four tendons around the shoulder joint. These muscles and tendons work together to provide the range of motion in the shoulder. Rotator cuff tears are a very common injury to the shoulder. This happens when one or more of the tendons tears fully or partially from the humerus. The tear can be either a partial tear, in which the tissue is damaged but not completely torn, or a full-thickness tear (complete tear) in which the tendon tears completely, frequently where the tendon attaches to the humerus. Eventually even the partial may start to fray and turn into a complete tear if not treated properly by an orthopedic specialist.
There are two types of rotator cuff injuries–acute and chronic (degenerative).
Acute Injury Tear
This type of tear occurs due to a traumatic event that injures the tendons, such as during a fall or a car accident. Frequently, acute tear injuries occur with other injuries, such as a dislocated shoulder or broken collarbone.
Chronic (Degenerative) Tear
Chronic tears occur when the tendons wear slowly over time and with age. Repetitive use over time, such as throwing, rowing, or other sports activities, can increase the risk of tears. Also, as we age, blood flow to the area is weakened and bone spurs can develop, both increasing the likelihood of tears.
Symptoms
In an acute tear, which happens suddenly, there is little doubt that there is an injury and it can be extremely painful. If this has happened to you, please call immediately and get help from a specialist here at YourOrthoSolution.
The most common symptoms of a partial rotator cuff tear include pain at night, especially when lying on the injured shoulder; pain in the shoulder when lifting and lowering the arm or certain range of motion movements; and weakness in trying to rotate or lift your arm. Cracking sensations and sounds may happen as you move your shoulder as well. Many of these symptoms may develop slowly and worsen over time.
A torn rotator cuff will weaken your shoulder making normal activities difficult, especially those requiring you to raise your arm.
Treatment
If you have shoulder pain, it is best to seek professional help sooner rather than later. If the pain turns out to be from a rotator cuff tear, continued use and fighting through the pain could exacerbate the problem and make the injury more severe. The earlier you seek treatment advice, the more likely you are to get back to the things you love doing at a faster pace and escape further damage.
Our goal here at YourOrthoSolution is to reduce your pain, increase your mobility, and get you back to the things you love. We believe the best treatment option is different for every person. We take a customized approach to your treatment plan and what your body will best handle to get you back to full strength the quickest and doing what you love. There are many things we consider when making an evaluation and designing the treatment plan, such as your age, activity level, general health and, of course, the type of tear you have.
Nonsurgical Treatments
Depending on the tear, approximately half of patients respond to nonsurgical treatment for pain relief and improved function; however, shoulder strength typically does not improve without surgery. Nonsurgical treatment options may include resting of the shoulder or modified activity, anti-inflammatories, physical therapy and steroid injections of an anti-inflammatory such as cortisone. Unfortunately, because nonsurgical treatments do not improve shoulder strength and, over time, there is a risk for a partial tear to worsen and become a complete tear. Your doctor may also recommend that you limit your activity while you are healing.
Surgical Treatments
If nonsurgical treatment methods do not improve your pain, your doctor may recommend surgical treatments. Additionally, to regain your original shoulder strength, surgery is typically required and involves reattaching the tendon to the humerus.
There are three common techniques used for rotator cuff repair today. These include traditional open repair, arthroscopic repair, and mini-open repair.
Open Repair
The open incision can be several centimeters long and is made over the shoulder and detaches the shoulder muscle or deltoid to better access to the torn tendon. Open repair can be used if the tear is extremely complex or if additional reconstruction is required. Although open repair was the standard method many years ago, new technology leading to less invasive procedures has been developed, and open repair is not common now.
Minimally Invasive or Arthroscopic
There have been many advances in the minimally invasive approach to all surgeries, including rotator cuff repair. After inserting a small camera, called an arthroscope, into the shoulder joint, the camera displays pictures on a high-definition television screen that allows the surgeon to guide miniature surgical instruments and repair the tear through a small incision (approximately 1 cm). This procedure is almost always performed at an outpatient surgery center and is, by far, the least invasive way to repair a rotator cuff tear. The small incision is less traumatic to the muscle and causes less bleeding and scarring, leading to faster recovery time.
Mini-Open Repair
Mini-open repair uses technology and instruments to perform a repair through a small incision (typically 3- to 5-cm long), similar to a minimally invasive approach. This technique first uses a arthroscopic technique to assess and treat damage to other structures within the joint, avoiding the need to detach the deltoid muscle. Once this is done, the incision is extended 1–2 cm (the mini-open), and the fibers of the deltoid muscle are split in line to obtain access for secure bone-tendon fixation. Because much of the procedure is done arthroscopically, the recovery time is much less than with the traditional open approach.
Physical Therapy
After surgery, you will typically have your arm immobilized in a sling for up to four to six weeks. Once it is safe for you to start moving your arm and shoulder, a physical therapist will help you with passive exercises to improve range of motion in your shoulder. During these passive exercises, your therapist helps support your arm and moves it in different positions. Typically, this type of program can start four to six weeks after surgery.
After four to six weeks of passive exercises, an active exercise program will begin. This will be a routine of exercises without the help of your therapist. You will gradually increase your strength and improve your mobility. At eight to twelve weeks, you can start a strengthening program.
Most patients have a decent range of motion and strength within four to six months after surgery, but it will take several months for a complete recovery. The surgery is just the start; rehabilitation is what it takes to get you back to the things you love and a complete recovery.
Here at YourOrthoSolution, we have some of the top orthopedic surgeons and sports medicine physicians in the country. We are dedicated to getting you back to the things you love through a customized plan that fits only you. Our caring team always goes that extra step to make you feel a part of our family. We specialize in treating injuries, including rotator cuff issues, and want to help you start the healing process as quickly as possible to get you on the path to recovery. As with all of our procedures and treatments, the goal is to get you back to full strength and doing the activities you want to do. Our highly trained specialists will take into account several factors and create a customized treatment plan for you and your needs.
At YourOrthoSolution, all of our doctors and staff are dedicated to ensuring that you not only receive the best orthopedic care in the area but also have an exceptional experience each time you visit our locations. Our dedicated staff will handle all insurance processes for you. You can expect to be in a friendly atmosphere and receive top orthopedic treatment to help you return to full mobility as quickly as possible.
