What is it?
The rotator cuff is made up of four muscles and their tendons. It helps to lift and rotate the arm and to stabilize the ball of the shoulder within the joint. Tears can be caused by acute trauma or repetitive activities such as painting or stocking shelves. Athletes such as swimmers, pitchers and tennis players can also be at risk for a rotator cuff tear.
If the tear is caused by an acute trauma, pain may develop immediately. More commonly, the pain comes on gradually and may be caused by repetitive overhead motion or by degeneration of the tendon. You may feel pain in the front of your shoulder that radiates down the side of your arm. Loss of overhead strength is another common symptom.
Treatment
Once your doctor diagnoses a rotator cuff tear, you may be told to rest the shoulder or use a sling. Your doctor may also suggest an anti-inflammatory medication or steroid injection. If the pain is not lessened, you may want to consider having it surgically repaired.
In general, there are three surgical approaches available:
Arthroscopic Repair
Arthroscopic surgery involves the use of a special camera attached to a long, narrow surgical scope. The scope is connected to a television monitor so the surgeon can visualize the inside of the joint. Working through very small (1 centimeter) incisions on each side of the shoulder joint, the surgeon can use specialized instruments to repair damaged cartilage, tendon, and other tissues.
This is a more recent development in treatment of rotator cuff tears, and not all types of tears can be treated by this method. The advantages of arthroscopic surgery are smaller incisions and less tissue damage. Because the approach is less invasive and does not require splitting muscle layers in the same way that the traditional approach does, the patient’s pain is usually also decreased.
Mini-Open Repair
The mini-open method of repairing a rotator cuff involves both the use of an arthroscope, and a short incision to get access to torn tendon. The incision is about 3-4 cm, and the associated trauma is less significant than with the open cuff repair.
Open Surgical Repair
Prior to the use of the arthroscope, all rotator cuffs were repaired by looking directly at the torn tendon, through an incision about 6-10 centimeters in length. The advantage is the rotator cuff tendons are easily seen by this method, but the incision is large, and the recovery can be longer and more painful. Still, a traditional open surgical incision is often required if the tear is large or complex or if additional reconstruction such as a tendon transfer has to be done. In some severe cases, where arthritis has developed, shoulder replacement is an option.
Your surgeon will recommend which technique is best for you.
Rehabilitation
After surgery, the arm is usually immobilized to allow the tear to heal. You will also be given an exercise program to help regain motion and strength in the shoulder. Physical therapy will generally begin about two weeks after surgery. Complete recovery can take at least four to six months.
You can have a significant impact on your recovery by making a strong commitment to rehabilitation. Your doctor will advise you when it is safe to return to activities that require overhead motion.