What Are Rotator Cuff Repairs?
The rotator cuff is a group of muscles and tendons that holds the shoulder together and helps lift and rotate the arm. When one of these muscles or tendons is injured, pain, weakness and loss of range of motion can occur.
Rotator cuff repair means surgically reattaching the torn tendon to the humerus (upper arm bone). This can be done through either an arthoscopic or open technique.
Common Reasons for Rotator Cuff Repair
Rotator cuff injuries are usually caused by overuse. Any job or activity that involves repetitive overhead movement—such as baseball, weight lifting, painting or shelf stocking—can result in an overuse injury. The blood supply to the rotator cuff can diminish due to older age, increasing the risk of injury. Between 10 and 40 percent of people over 60 years old have a rotator cuff tear, supporting its classification as a degenerative condition.
Candidates for Rotator Cuff Repair Surgery
Many rotator cuff injuries can be managed through nonsurgical treatments, such as anti-inflammatories, rest, ice and physical therapy. Good candidates for rotator cuff repair surgery include people who have:
- A tendon tear larger than two centimeters (cm)
- Acute tears (such as that after an injury) or known tears that are enlarging
- Significant weakness in the shoulder
- Tears in younger, more active patients
- Tried conservative treatments without success
There are two common options for rotator cuff repair surgery. These surgeries are done under a combination of regional and general anesthesia, with the surgeon reattaching the torn tendon to the humerus using sutures and implants known as anchors.
Open surgery: This type of surgery uses a three to five centimeter incision. The deltoid muscle is detached and moved aside to give the surgeon access to the rotator cuff. During an open repair the surgeon will often take care of other problems such as bone spurs or impingement.
Arthroscopic surgery: An arthroscopic surgery uses small tools and a special camera called an arthroscope attached to a video monitor. This eliminates the need for making a large incision and moving the deltoid muscle.
Rotator cuff tendons require approximately three to six months to heal to bone, regardless of the operative technique chosen. There will be some discomfort after each type of surgery, which can be controlled in the short term by a number of pain control methods.
Physical therapy is an important part of the recovery process. The goals of physical therapy include strengthening the shoulder muscles and restoring range of motion. The affected shoulder will initially be immobilized for a period of four to six weeks. The initial goal of therapy is to restore pain-free passive and active range of motion. As the tendon heals, strengthening exercises are added.
Most people have enough strength and range of motion for a return to normalcy in six months after the surgery. Complete recovery may take longer. On average, patients have about 75 percent of the total pain relief for three months postoperatively and 90 percent of their total pain relief six months postoperatively.
Function returns more slowly. At three months, most patients have about 50 percent of their function and at six months they have about 80 percent of their function. Improvement after rotator cuff repair can occur for up to one to two years. However, most failures will occur by six months postoperatively. Therefore, if the patient is progressing well at that time, the prognosis for a long-term successful outcome is high.
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