Rotator Cuff Tears
The rotator cuff is a group of four muscles in the shoulder connected via tendons to the upper arm (humerus). These muscles are responsible for arm’s movement, primarily the ability to lift and rotate the arm. Additionally, they help hold the ball of the humerus firmly in the shoulder socket.
The rotator cuff tendons can tear due to various reasons such as falling, mechanical injuries and frequent overhead activity (e.g.: painting, tennis, basketball etc.). The frequency of rotator cuff tears increases with age. Some injuries only slightly damage or irritate the tendon; in other situations, the tendon tears completely, disconnects and removes from the bone.
While rotator cuff tears are not a life threatening condition, they can be very painful and impact one’s daily activities. Moreover, they affect the ability of the arm to move properly, making simple functions, such as lifting a briefcase or combing hair, difficult and painful. Pain may vary but is generally worsening at night, especially when lying on the shoulder.
In addition, larger tears may be more difficult to treat and have a higher chance of recurrence.
Conservative care is offered to patients before surgery. The treatment may vary across doctors and may include one or all of the following:
- Medications – Drugs, which are not intended to treat the injury but rather to alleviate pain, include anti-inflammatory medications. A local anesthetic or steroid injection can be used to block the pain after which anti-inflammatory treatment can commence.
- Physical Therapy – Treatment generally begins with preliminary rest and restriction from activities. A passive range-of-motion program is started to help prevent stiffness and maintain joint use.
- Alternative Treatments – Some patients find that treatments such as shiatsu and acupuncture are helpful, despite the fact that there is no scientific evidence that they are effective.
Patients who do not respond to or are unsatisfied with non-operative treatment may seek surgical treatment.
Surgery may be considered to repair the torn tendons. There are several different surgical options for rotator cuff repair:
- Arthroscopic debridement of the joint
- Partial rotator cuff repair
- Complete rotator cuff repair
- Replacement of the shoulder joint (Reverse total shoulder arthroplasty)
A complete rotator cuff tear repair involves connecting the torn rotator cuff by suturing the tendon back together with the bone (the ball of the humerus). This is usually undertaken by placing an anchor in the bone at the attachment site and suturing the torn tendon end back down to the bone from which it originally tore away. During surgery the doctor may conduct additional procedures such as a debridement, which removes soft tissue or bone fragments that may be connected to the bone; and/or acromioplasty, which shaves some of the bone underneath the shoulder blade to give the tendon additional movement space.
If the above surgery cannot be performed, and your rotator cuff is deemed irreparable, your doctor may recommend replacement of the shoulder joint, procedure called reverse total shoulder arthroplasty. During surgery, the orientation of the shoulder is altered. The normal socket is replaced with a metal ball, and the normal ball (humeral head) is replaced with a humeral stem with a socket. Shoulder mechanics are changed so that some of the muscles gain tension and your ability to raise the arm is restored while lessening pain.
Your doctor will provide a recommendation for which surgical option is most appropriate following a thorough evaluation of your shoulder and medical history.
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