When it comes to rotator cuff tears, due to the degeneration associated with the natural aging process, the elderly are at the greatest risk. Most tears occur in the dominant arm or an arm with a shoulder that has previously sustained an injury. With a partial tear, if the conservative treatment methods are unsuccessful and the pain continues, the doctor may recommend torn rotator cuff surgery. When the rotator cuff tears completely, surgical intervention is required.
An Injured Shoulder May Require Torn Rotator Cuff Surgery
The rotator cuff is composed of the tendons and muscles that surround the shoulder’s ball-and-socket joint. The best way to visualize the rotator cuff is to think about it as a thick rope consisting of small threads. If a few of these threads tear, those that remain continue providing the strength necessary to keep pulling and lifting heavy loads. When only a partial tear is present, conservative treatments may be beneficial.
Nonetheless, if every thread tears completely, the muscle is unable to function. In this case, correcting the tear and returning shoulder function requires torn rotator cuff surgery.
Recognizing the Symptoms of a Torn Rotator Cuff
A partial tear in the rotator cuff can cause a variety of symptoms including inflammation, pain in the shoulder, tenderness, tendonitis, weakness and a decrease in the shoulder joint’s range of motion (i.e., limited mobility).
Reasons Torn Rotator Cuff Surgery May Be Recommended
Ongoing pain after completion of the conservative treatment protocol for a partially torn rotator cuff is one of the main reasons a doctor recommends surgery. In addition, the doctor may suggest surgery for individuals with a partial tear who are very active (e.g., participate in sports or frequently raise their arms over their head while working).
Other Signs You Might Need Rotator Cuff Surgery
The tear is large (more than 3 cm) and the tissue surrounding the torn tendon is of good quality.
Symptoms are chronic, lasting from six to 12 months.
The tear resulted from a relatively recent, acute injury.
The shoulder is exhibiting limited motion.
The Most Common Torn Rotator Cuff Surgery Techniques
The three torn rotator cuff surgery techniques used most frequently include the all-arthroscopic repair, the mini-open repair and the traditional open repair.
After creating a small incision, the surgeon inserts a tiny camera (i.e., an arthroscope) into the patient’s shoulder joint. The arthroscope allows the surgeon to see inside the shoulder joint via a video monitor. The surgeon uses miniature surgical instruments to repair the torn tendon.
A Mini-Open Repair
The incision for a mini-open repair is usually 3 cm to 5 cm long. During the mini-open repair, arthroscopy is utilized for assessing and treating other structures that have sustained damage. For instance, bone spurs are frequently removed while the surgeon performs arthroscopy. When removing bone spurs during traditional open repair surgery, the deltoid muscle must be detached. However, by removing these spurs during arthroscopic surgery, the patient’s deltoid muscle remains in place.
After completing the arthroscopic portion of the procedure, the surgeon repairs the tendon. While repairing the tendon, instead of using a video monitor, the surgeon views the structures of the shoulder directly.
An Open Repair — Used for a Large or Complex Tear and Reconstruction
The traditional open repair requires an incision that is several centimeters long. The surgeon creates this incision over the patient’s shoulder and then detaches the deltoid muscle. Besides providing the surgeon with a better view, detaching this muscle provides the surgeon with a way to access the torn tendon.
What to Expect After Torn Rotator Cuff Surgery
Following surgery patients should expect to feel pain. This is completely natural. Pain management is an important aspect of the recovery process, therefore, the surgeon and medical staff work together to manage the patient’s pain.
One of the most common recovery tools for addressing pain is prescribed and over-the-counter pain medications. The pain medications available range from opioids to non-steroidal anti-inflammatory drugs (NSAIDs) to local anesthetics. Some surgeons have their patients take a combination of medications. By creating an effective combination of over-the-counter pain relief medication, the need for opioids is reduced.
The Importance of Reducing Opioid Use
Although opioids work well for pain relief after surgery, prolonged use of opioids is not recommended because this medication is a narcotic, and it can be addictive. For this reason, opioids must be taken as directed. Once the patient’s pain decreases, he or she should discontinue taking the opioids and begin taking the recommended over-the-counter medication. If several weeks have passed and the pain shows no improvement, patients need to speak with their surgeon.
Rehabilitation with a Physical Therapy Program is Crucial
The physical therapy program following torn rotator cuff surgery includes:
Immobilization — From Four to Six Weeks
Initially, the tendon needs to heal. To accomplish this, the arm must remain stable. Patients should expect to receive a sling. This sling is worn from four to six weeks. During this four to six-week period, patients must refrain from using their arm. The length of time a patient wears the sling is based on the severity of the injury.
Passive Exercise — Lasts Four to Six Weeks
Despite the torn rotator cuff being repaired, the arm muscles remain weak. At some point, the surgeon determines that it is safe for the patient to move his or her shoulder and arm. This is when passive exercise begins. These exercises are used to improve range of motion. While performing passive exercises, the therapist supports the patient’s arm while moving it into different positions.
Active Exercise — Lasts Eight to 12 weeks
Once active exercise begins, the patient performs these exercises without assistance from the therapist. By actively moving the muscles, the strength of the arm and the patient’s ability to control it improve. After completing active exercise, the therapist begins teaching the patient strengthening exercises.
Complete Recovery – Several Months
Most patients’ range of motion improves, and they have a sufficient amount of strength about four to six months after their torn rotator cuff surgery. Although the recovery following rotator cuff surgery is lengthy, being committed to the rehabilitation process is the key to a successful recovery.
Cameron Can Help You
An orthopaedic specialist is an invaluable resource for treating shoulder pain. From minor injuries like torn cartilage to facilitating your knee surgery, an orthopaedic surgeon offers precise expertise designed to increase your mobility, reduce your pain and get your life back on track.
Cameron Hospital’s Orthopaedics Clinic is fully equipped to diagnose and treat your knee pain. Our specialists are here to help you find the relief you need. Learn more about how we can do so by scheduling an appointment or contacting us today.
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