Shoulder Surgery – Rotator Cuff
Injuries to the rotator cuff of the shoulder can effect both the athletic population and workplace. They are common overuse injuries that can affect anyone from younger athletes to older adults. In 2013, nearly 2 million people in the US had a rotator cuff problem. These injuries can occur from either acute trauma or repetitive motions and are commonly seen in patients who do repetitive lifting or overhead activities. Rotator cuff degeneration and tears can also occur overtime due to aging. When the rotator cuff is torn, a patient may feel recurrent pain, limited arm mobility, and muscle weakness.
The shoulder is the most mobile joint in the body. The joint is formed at the junction of three bones: the shoulder blade (scapula), the collarbone (clavicle), and the upper arm bone (humerus). The shoulder is a ball and socket joint where the head of the humerus rests in a socket in the shoulder blade called the glenoid. The rotator cuff is a group of muscles and tendons that surround the shoulder and attach to the head of the humerus. The rotator cuff keeps your arm in your shoulder socket and enables you to lift and rotate your arm.
Diagnosis of these injuries is often made clinically. X-rays and magnetic imaging studies (MRI) can also be helpful in confirming the diagnosis. Once a diagnosis is made both conservative and operative treatment options can be exercised.
Conservative treatment involves rest, physical therapy to work on shoulder mobility and muscular strengthening, and anti-inflammatory medications or injections. These treatments help to minimize pain and stabilize the shoulder. It is an effective form of treatment for patients with a partial thickness rotator cuff tear who are not experiencing weakness and pain. In patients where improvement is not obtained after a thorough rehabilitation program, surgical options offer an alternative in preventing recurrent instability and return to function.
Surgical management of these injuries focuses on repairing the torn rotator cuff tendon so that it can heal. Surgery is optimal for patients whose symptoms do not improve through rehabilitation despite partial tearing or for patients who have a full-thickness rotator cuff tear. Rotator cuff surgery involves either arthroscopic surgery or open surgery of the shoulder depending on the complexity of the tear. During surgery, injured tendons and muscles are reattached using sutures and bone anchors. Bone spurs, if present, can also be removed at the time of surgery. The goal of this procedure is to restore shoulder function, strength, and range of motion so that the patient can successfully return to full activity at 4 – 6 months. A general guideline of rotator cuff tear rehabilitation can be found within the Rehabilitation Protocols.