Rotator Cuff Repair:
Advances in non-surgical care and the operating room benefit patients of all ages
By Samuel Brown, MD
Effective repair of rotator cuff tears is frequently possible in most patients, no matter how major their injury or advanced their age.
However, the best results depend on prompt and accurate diagnosis, effective use of non-invasive therapies or surgery, and carefully managed rehabilitation. Specialized care can help almost all patients return to their favorite activities and avoid long term shoulder pain and arthritis.
Tears of the rotator cuff – a group of four muscles and their tendons that converge at the greater tuberosity of the humerus in the shoulder – are extremely common. Tears can be acute or degenerative, caused by falls, repetitive stresses in athletics or normal wear-and-tear of age. They are often preceded by a condition called shoulder impingement syndrome, which is compression of the rotator cuff in the narrow subacromial space.
One common misconception is that everyone with a rotator cuff “tear” requires surgery. In fact, many patients with partial tears or worn, fraying areas of a tendon can improve without surgery. Non-steroidal anti-inflammatory medications, strengthening exercises and physical therapy may help. Others with more serious tears will benefit from arthroscopic surgery, a minimally-invasive outpatient procedure.
Full-thickness tears, in which the tendon is torn away from the bone, are more significant. New suture anchors and techniques have reduced surgical times, minimized the rate of complications and allowed us to fix injuries once considered “untreatable”.
The rehabilitation period remains significant, requiring gradual but steady strengthening without risking another tear. Physical therapy may range from six to eight weeks up to two to three months, depending on a patient’s injury and age. Since each individual is different, long-term success is best achieved with close coordination between a surgeon and physical therapy team. Every case is different.
Early diagnosis and intervention is critical. Symptoms of rotator cuff injury include night pain and pain with activity; discomfort when raising or lowering the arm, weakness when lifting or rotating the arm and a grinding sensation with shoulder movement also may occur.
If left untreated, damage can progress to adhesive capsulitis, or frozen shoulder syndrome, which is marked by extreme stiffness and pain, limited range of motion and the development of scar tissue that complicates any future attempt at repair and rehabilitation. Unrepaired patients also might suffer from cuff tear arthropathy, a debilitating form of shoulder arthritis.
As a result, we encourage primary care physicians to refer patients of all ages – not just the young or athletic – to a specialist. Even patients in their 80s and 90s can see a dramatic improvement in their daily lives with proper care. Our philosophy is that a patient doesn’t have to be a professional athlete to be treated like one!
Dr. Brown is an Orthopaedic Surgeon and specialist in Sports Medicine, with fellowship training in shoulder disorder. He is one of the original members of Sports Medicine & Orthopaedic Center, Inc., and recently became President of the Southern Orthopaedic Association. smoc-pt.com
