Rotator cuff tears
Description
The rotator cuff is made up of 4 muscles which begin deep in the chest (on the scapula). As they travel outward, the muscle tissue becomes tendon tissue and then they attach to the top of the arm bone (humerus) as a "cuff" of tissue. They are responsible for allowing us to rotate and elevate our arm. That is how they get the name "rotator cuff".
Pathology
Sometimes one or more of the rotator cuff tendons can become detached from the humerus...this is called a rotator cuff tear. This can happen all of the sudden with a traumatic event or more commonly can occur slowly over time. As we age the quality and elasticity of the tissue changes and makes us more prone to tears in the rotator cuff. Also as we age, we all develop changes in the anatomy of the bones in the shoulder and often this change can become a bone spur. Bone spurs can make tears in the rotator cuff worse.
Symptoms
Typically rotator cuff tears will cause PAIN. It is often pain in the shoulder as well as pain in the arm. Sometimes the pain travels up the neck as well. Pain at night is extremely common. Pain with certain arm movements is also a common symptom. Another common symptom is weakness.
Treatment Options
Once a diagnosis of rotator cuff tear has been made, Dr. Brady will discuss treatment options with you. In general there are four treatment options.
- Do nothing and live with the pain / weakness: This is not cancer and will not kill you but living with the discomfort and weakness can be quite difficult. Doing nothing is always an option.
- Anti-inflammatory medication / cortisone (steroid) injections: This can help you live with your shoulder. The goal is to reduce your pain. This option will not increase your strength or repair the torn rotator cuff however.
- Physical Therapy: PT can help maximize your strength. By strengthening the muscles around the torn rotator cuff muscle, your strength can improve substantially. This is sometimes most beneficial in the case of a chronic rotator cuff tear
- Arthroscopic Rotator Cuff Repair: This option repairs the torn tendon back down to the bone. After sufficient rehabilitation, the goal is both to eleviate pain and to restore strength. This is a very safe and effective surgery but does require some time for rehabilitation
Treatment Options: Arthroscopic Rotator Cuff Repair
Dr. Brady repairs ALL rotator cuff tears arthroscopically. This means that instead of having to make a large incision around the shoulder to reach inside the shoulder and pull the rotator cuff back down to the bone, he performs the entire procedure through small nicks in the skin and uses a camera and small surgical instruments to repair everything in the shoulder. Since the camera is extremely small he can position the camera ANYWHERE in the shoulder and see things much better this way. He is experienced in performing many arthroscopic release procedures if your cuff tear is somewhat large and immobile.
The primary goal of surgical treatment is pain relief and it is quite effective. Over 90% of patients experience substantial or total pain relief. The second goal is restoration of strength. Strength restoration is dependant on a multitude of factors. Dr. Brady typically recommends surgery if nonoperative treatment does not relieve your symptoms. Surgery may also be considered if the tear is acute and painful, if it is the dominant arm of an active individual or if you need maximum strength in your arm for overhead work or sports.
In the operating room, Dr. Brady will also remove any 'bone spurs' within your shoulder. This is done at the same time utilizing the same arthroscopic tools. Other conditions such as arthritis of the AC joint or tearing of the biceps tendon may also be addressed.
Rehabilitation
After surgery, the arm is immobilized to allow the tear to heal. The length of immobilization depends upon the severity of the tear. You will be given an exercise program to help regain motion and strength in the shoulder. This begins with passive motion. It advances to active and resistive exercises. Dr. Brady may recommend that you work with a physical therapist. Complete recovery may take up to 6 months.
A strong commitment to rehabilitation is important to achieve a good surgical outcome. The doctor will advise you when it is safe to return to overhead work and sports activity.
Research on the Horizon/What's New?
Dr. Brady utilizes dissolvable suture anchors. These are the small screws that hold stitches in place or hold stitches down to bone until the repair has healed and then they are absorbed by the body. Research is also being done on "orthobiologic" tissue implants. These promote growth of new tissue in the body, and help with the healing process.