Rotator Cuff Tears: Surgical Treatment Options - OrthoInfo .
Rotator Cuff Tears: Surgical Treatment Options - OrthoInfo - AAOS6/14/19, 2:10 PMTREATMENTRotator Cuff Tears: Surgical TreatmentOptionsThe following article provides in-depth information about surgical treatment for rotator cuffinjuries, and is a continuation of the article "Rotator Cuff Tears." For a good introduction to the topicof rotator cuff injuries, please refer to Rotator Cuff ).Surgery to repair a torn rotator cuff most often involves re-attaching the tendon to the head ofhumerus (upper arm bone). A partial tear, however, may need only a trimming or smoothingprocedure called a debridement. A complete tear is repaired by stitching the tendon back to itsoriginal site on the humerus.The rotator cuff tendons cover the head of the humerus(upper arm bone), helping you to raise and rotate yourarm.When Rotator Cuff Surgery is e 1 of 8
Rotator Cuff Tears: Surgical Treatment Options - OrthoInfo - AAOS6/14/19, 2:10 PMYour doctor may offer surgery as an option for a torn rotator cuff if your pain does not improvewith nonsurgical methods. Continued pain is the main indication for surgery. If you are veryactive and use your arms for overhead work or sports, your doctor may also suggest surgery.Other signs that surgery may be a good option for you include:Your symptoms have lasted 6 to 12 monthsYou have a large tear (more than 3 cm) and the quality of the surrounding tendon tissue isgoodYou have significant weakness and loss of function in your shoulderYour tear was caused by a recent, acute injuryFront (left) and overhead (right) viewsof the tendons that form the rotatorcuff. The blue arrows indicate a fullthickness tear in the supraspinatustendon, the most common location forrotator cuff tears.Surgical Repair OptionsThere are a few options for repairing rotator cuff tears. Advancements in surgical techniques forrotator cuff repair include less invasive procedures. While each of the methods available has itsown advantages and disadvantages, all have the same goal: getting the tendon to heal.The type of repair performed depends on several factors, including your surgeon's experienceand familiarity with a particular procedure, the size of your tear, your anatomy, and the qualityof the tendon tissue and bone.Many surgical repairs can be done on an outpatient basis and do not require you to stayovernight in the hospital. Your orthopaedic surgeon will discuss with you the best procedure tomeet your individual health tor-cuff-tears-surgical-treatment-options/Page 2 of 8
Rotator Cuff Tears: Surgical Treatment Options - OrthoInfo - AAOS6/14/19, 2:10 PMYou may have other shoulder problems in addition to a rotator cuff tear, such as biceps tendontears, osteoarthritis, bone spurs, or other soft tissue tears. During the operation, your surgeonmay be able to take care of these problems, as well.The three techniques most commonly used for rotator cuff repair include traditional open repair,arthroscopic repair, and mini-open repair. In the end, patients rate all three repair methods thesame for pain relief, strength improvement, and overall satisfaction.Open RepairA traditional open surgical incision (several centimeters long) is often required if the tear is largeor complex. The surgeon makes the incision over the shoulder and detaches one of the shouldermuscles (deltoid) to better see and gain access to the torn tendon.During an open repair, the surgeon typically removes bone spurs from the underside of theacromion (this procedure is called an acromioplasty). An open repair may be a good option if thetear is large or complex or if additional reconstruction, such as a tendon transfer, is indicated.Open repair was the first technique used for torn rotator cuffs. Over the years, new technologyand improved surgeon experience has led to less invasive procedures.All-Arthroscopic RepairDuring arthroscopy, your surgeon inserts a small camera, called an arthroscope, into yourshoulder joint. The camera displays pictures on a television screen, and your surgeon uses theseimages to guide miniature surgical instruments.During athroscopy, your surgeon can see the structures ofyour shoulder in great detail on a video tator-cuff-tears-surgical-treatment-options/Page 3 of 8
Rotator Cuff Tears: Surgical Treatment Options - OrthoInfo - AAOS6/14/19, 2:10 PMBecause the arthroscope and surgical instruments are thin, your surgeon can use very smallincisions (cuts), rather than the larger incision needed for standard, open surgery.Illustration and photo show anarthroscope and surgical instrumentsinserted through portals in a shoulderjoint.All-arthroscopic repair is usually an outpatient procedure and is the least invasive method torepair a torn rotator cuff.(Left) Arthroscopic view of a healthyshoulder joint.(Right) In this image of a rotator cufftear, a large gap can be seen betweenthe edge of the rotator cuff tendon andthe humeral head.(Left) The same rotator cuff tear, asseen from above the tendon.(Right) The rotator cuff tendon hasbeen re-attached to the greatertuberosity of the humeral head withsutures.Mini-Open RepairThe mini-open repair uses newer technology and instruments to perform a repair through asmall incision. The incision is typically 3 to 5 cm or-cuff-tears-surgical-treatment-options/Page 4 of 8
Rotator Cuff Tears: Surgical Treatment Options - OrthoInfo - AAOS6/14/19, 2:10 PMThis technique uses arthroscopy to assess and treat damage to other structures within the joint.Bone spurs, for example, are often removed arthroscopically. This avoids the need to detach thedeltoid muscle.Once the arthroscopic portion of the procedure is completed, the surgeon repairs the rotator cuffthrough the mini-open incision. During the tendon repair, the surgeon views the shoulderstructures directly, rather than through the video monitor.RecoveryPain ManagementAfter surgery, you will feel pain. This is a natural part of the healing process. Your doctor andnurses will work to reduce your pain, which can help you recover from surgery faster.Medications are often prescribed for short-term pain relief after surgery. Many types ofmedicines are available to help manage pain, including opioids, non-steroidal anti-inflammatorydrugs (NSAIDs), and local anesthetics. Your doctor may use a combination of these medicationsto improve pain relief, as well as minimize the need for opioids.Be aware that although opioids help relieve pain after surgery, they are a narcotic and can beaddictive. Opioid dependency and overdose has become a critical public health issue. It isimportant to use opioids only as directed by your doctor. As soon as your pain begins to improve,stop taking opioids. Talk to your doctor if your pain has not begun to improve within a fewweeks after your surgery.RehabilitationRehabilitation plays a vital role in getting you back to your daily activities. A physical therapyprogram will help you regain shoulder strength and motion.Immobilization. After surgery, therapy progresses in stages. At first, the repair needs to beprotected while the tendon heals. To keep your arm from moving, you will most likely use a slingand avoid using your arm for the first 4 to 6 weeks. How long you require a sling depends uponthe severity of your ator-cuff-tears-surgical-treatment-options/Page 5 of 8
Rotator Cuff Tears: Surgical Treatment Options - OrthoInfo - AAOS6/14/19, 2:10 PMPassive exercise. Even though your tear has been repaired, the musclesaround your arm remain weak. Once your surgeon decides it is safe foryou to move your arm and shoulder, a therapist will help you withpassive exercises to improve range of motion in your shoulder. Withpassive exercise, your therapist supports
(Left) The same rotator cuff tear, as seen from above the tendon. (Right) The rotator cuff tendon has been re-attached to the greater tuberosity of the humeral head with sutures. Rotator Cuff Tears: Surgical Treatment Options - OrthoInfo - AAOS 6/14/19, 2:10 PM
demonstrate weakness or pain with tests of the rotator cuff. If a rotator cuff tear is suspected, we will next order an MRI. Magnetic Resonance imaging (MRI) is considered the gold standard for diagnosing rotator cuff tears, pre-operatively. These images will demonstrate tears of the rotator cuff. Treatment of Rotator Cuff Tears:
rotator cuff tendons also undergo some degeneration with age. This process alone can lead to rotator cuff tears in older patients. Patients over 50 years of age are more susceptible to sustaining a significant rotator cuff tear from trauma. Rotator cuff tears can be classified in various ways. The first classification is a partial thickness or .
Rotator cuff tears are very common. Trauma, such as falls, lifting, and pulling forcefully can also cause a rotator cuff tear. When this happens, it is called an acute tear. Although the rotator cuff can be damaged from a single trau-matic injury, damage to the rotator cuff usually occurs gradually. Age can be
First we recommend you read a Patient Guide to Rotator Cuff Tendinitis and also a Patient Guide to Partial Rotator Cuff Tears which have a lot of important information about your rotator cuff. Those two guides will help you understand the language used to discuss your rotator cuff such as “tendinosis,” “partial tear” and “full tear.”
rotator cuff tear JAMA. Rational clinical exam: Does this patient have rotator cuff disease? Aug 2013. Pain & Strength test: Subscapularis internal rotation lag test aka lift off [JAMA. Rational clinical exam: Does this patient have rotator cuff disease? Aug 2013. Positive LR 5.6 for full thickness rotator cuff tear. Negative LR 0.04.
Rotator Cuff Tears Aging adults with rotator cuff tears also commonly end up with biceps tendonitis. When the rotator cuff is torn, the humeral head is free to move too far up and forward in the shoulder socket and can impact the biceps tendon. The damage may begin to weaken the biceps tendon and cause it to become inflamed. Shoulder Impingement
A large number of these patients have injury to the rotator cuff. There is a range of severity in rotator cuff disease, which likely includes a high proportion of partial thickness tears (PTT). This condition is difficult to diagnose since current methods to identify PTT (imaging and physical
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