Rotator Cuff Repairs
Rotator cuff repairs, for any injury to the rotator cuff, will involve surgery.
The rotator cuff will not heal itself. That said, it is not always necessary to actually repair a torn rotator cuff tendon.
Cuff repairs, performed surgically, are often the last resort. The majority of rotator cuff tears are treated by a program of physical rehabilitation.
So just when is rotator cuff repair surgery required. There are a number of factors that would require surgery to be the first option
You can see from the limited list above that cuff repairs are much less common than rotator cuff tears. The age related entry is an interesting one to consider.
The vast majority of rotator cuff injuries occur in people over 40. The incidence of rotator cuff tears developing increases with age and a sedentary lifestyle.
Surgery v Exercise
So, if surgery is not the first option, what is? Not too difficult a question given the heading above. The vast majority of rotator cuff injuries are initially treated with a program of physical therapy and rehabilitation.
Even if surgery is performed it is not a one off cure all. Long term successful rotator cuff surgery recovery is dependant upon a number of factors.
One of the major factors relies upon the patient undertaking a period of physical therapy and rehabilitation. This is exactly the same program as if the injury had been treated without surgery.
In considering what action to take it is important to consider two key considerations. Namely, what the symptoms are and what a surgical intervention seeks to achieve.
In the case of a rotator cuff tear there are generally two significant symptoms i.e. pain and weakness. Often the pain will gradually wear off over a period of a few weeks / months. This leaves the weakness as the only significant symptom. This weakness is what is targeted by rehab exercise.
If the rotator cuff can be strengthened through a dedicated exercise program there will be no need for surgery. It is possible that if approached correctly the rotator cuff can be exercised to the point that it is stronger than it was before the tear occurred. I am, without doubt, proof of this, should any be needed.
It has to borne in mind that the tear will not heal through exercise alone. Rotator cuff repairs are required for that to be achieved. Successful surgical cuff repairs are achieved in over 90% of cases. But, if symptoms can be treated successfully without the inherent risks involved with surgery, everyone benefits.
Rotator cuff repairs
The aim of rotator cuff repair surgery is to reattach the rotator cuff tendon to the bone from which it has torn free.
<- - - Torn Rotator Cuff Image
The picture above shows a rotator cuff tendon tear just as it is about to be repaired.
This is, quite obviously, an “open repair”. A large percentage of rotator cuff repairs are now performed arthroscopically.
This involves making only small incisions, known as portals, into which are inserted a camera and various surgical tools.
The torn tendon is reattached to the bone using sutures.
Small rivets or suture anchors are drilled into the upper arm bone. The suture anchors can be either metal or made from a material that dissolves over time. Either way they do not have to be removed after the surgery.
Once the suture anchors are in place the surgeon will stitch through the damaged tendon. As he pulls the stitches tighter the tear in the tendon is closed. The tendon is brought back into contact with the upper arm bone where it is held securely until it heals.
The majority of cuff repairs are performed on an outpatient basis. Often a local anaesthetic is used and can be administered in such a way as to increase pain relief in the hours after the surgery has ended. Make no mistake you will be glad of it as this is a painful procedure to come out of.
Rotator cuff surgery recovery
Rotator cuff surgery recovery is not a short term matter. Complete recovery can take up to six months. It will be determined by a number of factors
Immediately after surgery, the arm is immobilized to allow the tear to heal. The length of immobilization depends upon the severity of the tear. This will generally be a period of weeks.
As described above an exercise program will help regain motion and strength in the shoulder. This program begins with passive motion and advances to active and resistive exercises.
A majority of surgeons confirm that it is poor adherence to this program that has the most negative effect upon successful outcomes.
Complete recovery may take several months. A doctor’s advice should be followed with regards to returning to work and sports.
This is especially important if it requires significant shoulder use especially any overhead work. Often a temporary change of duties should be sought.
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