Rotator cuff tears are a common condition that causes shoulder pain and dysfunction in over 20% of the general adult population, with a progressively higher incidence as age increases.
The primary causes are injury and degeneration. Whether you are a competitive player, weekend warrior, a devoted weight lifter, a heavy laborer or simply slipped and fell on your shoulder, it is important to seek treatment. Delaying can worsen your shoulder damage and increase the risk of a loss of function. Simple actions we take for granted can become impossible such as combing your hair, and even dangerous like lifting a heavy pot of boiling water.
Rotator Cuff surgery
Rotator cuff surgery may be performed as an open repair, arthroscopic repair or a combination. The goal of surgery is to reduce pain and restore function. In a majority of cases minimally invasive outpatient arthroscopic repair is favored because it offers significant benefits.
Benefits include small incisions, less tissue damage, less bleeding and less post-op discomfort, and quicker recovery than with open surgery.
What are the Indications for Rotator Cuff surgery?
- Continued pain, after conservative management, is a primary indication for surgery.
- Symptoms such as weakness and shoulder dysfunction that persist for 6-12 months and fail to improve with conservative measures.
- Large tears where conservative management is not the best option.
- Recent acute injury and severe tears in young, healthy individuals
- For patients with rotator cuff injury who are active in overhead sports or work, or repetitive activity, surgery may be the best option. In many cases, the patient will have an option for minimally invasive arthroscopic repair, mini-open or open repair.
Rotator cuff surgery
The surgical technique depends on Dr. Cooper’s and the patient’s preference. Typically, rotator cuff surgery is minimally invasive arthroscopic surgery. Using an arthroscope, Dr. Cooper will examine and treat the tear. It may involve reattaching the tendon to the bone with sutures; or
suturing the torn ends of the cuff together; or replacing the torn tendon with a graft. Additionally, Dr. Cooper may remove any bone spurs, smooth the joint surfaces; and debride the joint (clean out loose tendon fragments and other debris from inside the joint that can cause restricted motion, irritation and impingement issues).
The rotator cuff has poor healing ability for a number of reasons, one of which is an insufficient number of stem cells to aid in the healing of the bone and tendon. Biologic enhancement is now widely used to aid in healing the cuff with and without surgery whether that be marrow drilling during surgery to stimulate regenerative cellular response or potential platelet rich plasma injections. You can discuss this with Dr. Cooper.
Treatment for large, complex and degenerative tears
Large and complex cuff tears may require an open surgical repair depending on the type of tear (tendon torn off the bone) and the patient’s age, function and other comorbid conditions (arthritis). Most large tears are degenerative combined with an acute injury causing pain and enlarging the tear.
Degenerative rotator cuff tears are the most common cause of shoulder pain, weakness and loss of function and may respond well to conservative measures. Conservative management can help reduce symptoms but cannot restore the structure of the cuff, restore function or halt progression of the damage.
Shoulder Joint Replacement Surgery is often recommended when a patient has degenerative tears and
- Severe shoulder pain, that interferes with daily activities like reaching, dressing, etc.
- Moderate to severe pain at rest; pain that interferes with sleep.
- Loss of shoulder motion or weakness, and
- Failure to improve with conservative measures.
Rotator Cuff tears and arthritis
Rotator Cuff Arthropathy is arthritis of the shoulder joint associated with a massive rotator cuff tear. It affects about 4% of people with rotator cuff tears. Arthritis of the ball and socket shoulder joint with a significant tear causes progressive destruction of articular cartilage and bone; and leads to poor function and poor quality of life. Treatment is reverse shoulder joint replacement.
Reverse Total Shoulder Replacement
Reverse total shoulder replacement like conventional shoulder replacement surgery involves the replacement of the shoulder joint ball and socket with implants. However, this procedure is used often recommended for people with large rotator cuff tears and severe shoulder arthritis when the patient has previously had a shoulder replacement or has serious fractures of the arm bone.
Dr. Joe Cooper is a shoulder surgeon with the skills, experience and expertise to provide his patients with nonsurgical and surgical solutions to improve pain and restore function.