What is the function of the rotator cuff?
The ball and socket mechanism of your shoulder joint is covered by several tendons. These tendons are 4 and combined together they form a "cuff" over the upper part of the ball (humerus). These muscles originate from the scapula (shoulder blade) and insert on the ball. Their main function is to rotate the ball of the shoulder. They also provide stability to the shoulder.
How did I get a rotator cuff tear?
There are two types of rotator cuff tears. Those that are related to a trauma that caused the tear (heavy lifting etc) and those that happen due to wear and tear of the tendons over time. After the age of 40 the wear and tear process in your shoulder tendon begins and by age 65 approximately 50% of population will have a partial or complete rotator cuff tear.
How is it possible for so many people to have a rotator cuff tear and not have problems?
There are patients who have a rotator cuff degenerative tear and have no symptoms. A clear explanation does not exist, however it is possible that these patients compensate for the lost tendon with the other tendons. If the degenerative process is slow enough the other tendons may compensate for the loss.
If my MRI shows a rotator cuff tear and have no symptoms what should I do?
This tear is called an asymptomatic tear. A tear that is compensated. In that case your doctor will re-evaluate you every few months to make sure that the tear does not became symptomatic. As long you have no symptoms NO SURGERY IS NECESSARY.
If I have a painful rotator cuff and keep using it, will this cause further damage?
A rotator cuff tear can extend or get larger over time. This can occur with repetitive use or a re-injury. It is common for patients with known rotator cuff disease to have acute pain and weakness following a minor injury. This likely represents extension of an existing tear.
If you know you have a rotator cuff tear, then worsening pain and decreasing strength may mean the tear is getting larger.
When should I see a doctor for a rotator cuff tear?
If your shoulder had no pain and you start having pain or if you had a tear that caused no symptoms and you start having pain then you should see an orthopaedic surgeon. It is important to monitor the symptoms and the size of the tear from the onset of symptoms because if the tear gets larger it is more difficult to treat and has tendency to re-tear.
What can I do if I do not need surgery for the tear? How can I make it better?
Treatment can be done without surgery and improve symptoms if strengthening of the other tendon muscles is achieved with physical therapy or home therapy. The tendon will not heal but the symptoms may improved. In additon, anti-inflammatories or cortizone injections may be given however these have only temporary relief.
At what point does a rotator cuff tear require surgery to fix it?
There several situations that need surgery. A well functioning shoulder that losses strength and motion after an injury to the joint is an indication to do surgery. The traumatic tears need to be repaired within the first 2-4 weeks after the injury. If a degenerative tear is not responding to therapy and conservative treatment or changes in size and becomes bigger overtime then surgery will be required.
Patients who older than the age of 65, are diabetes, have a history of smoking or arthritis to the shoulder are not good candidates for surgery. They have lower satisfaction rates and higher re-tear rates over time. Active patients who use the arm for overhead work or sports are more in need for repair.
What is it done during surgery and how is it done?
Your doctor will examine your shoulder, discuss with you your lifestyle activities and other medical problems. He will also evaluate the tendons with an MRI and tell you what type of treatment you need. The surgical treatment options are outlined below and can be done with an arthroscopy (telescope) or with open surgery - mini or traditional open. There is no data to show that one method is better over the other:
(1) trimming or smoothing procedure called a débridement.
(2) A full-thickness tear within the substance of the tendon can be repaired side to side. If the tendon is torn from its insertion on the humerus, it is repaired directly to bone.
(3) Use of tissue to augment the tendon repair. The results are not encouraging in terms of healing
(4) Partial repair. If the tendon is not long enough to be repaired back to bone then a partial repair is done.
How important is rehabilitation in the treatment of a rotator cuff tear?
Following your doctors protocol of surgical repair is critical especially protecting your arm for the first 6 to 12 weeks after the surgery. Studies show that early motion of your arm versus late motion of your arm has no effect on the result of your surgery. Exercise of your arm when it is safe for the repair will strengthen your other tendons and protect your repair.
How often will I be attending physical therapy? For how long?
In most cases you will attend physical therapy 1-3 times a week for 8-12 weeks post-op. Sometimes the program may last for 6 months after your surgery.
Are hot or cold packs better for my shoulder after surgery?
Hot packs sometimes feel "good" to the shoulder. However, studies show that the swelling of the shoulder reduces with the use of cold packs.
When can I begin to drive?
Approximately 4-6 weeks from time of surgery. The criteria for driving are as follows:
• Once you are no longer taking narcotic pain medications during the day.
• Ability to safely control steering wheel with minimal use of involved shoulder and no discomfort doing so.
• Automatic transmission only during the first 4-6 weeks.
When can I go back to work after surgery?
Depending on whether or not light duty is available, you could return as soon as 1-2 weeks. If your occupation requires raising of arms overhead, reaching or lifting, then approximately 8-12 weeks.
Will I need to wear a sling for any extended period of time?
For the first 6 weeks it is critical to wear your sling that will protect you from a possible injury to the repair in case of a fall or accident. Your doctor may modify this time frame based on the size of the tear and your progress of healing.
When can I begin to raise/lift the arm on my own after the surgery?
For 6 weeks no motion of your arm is allowed by activating your own muscles (doing it on your own). The physical therapist will raise the arm for you and you will not apply any force. If you have no physical therapy prescribed you need to assist with your other arm to lift the arm for the first 6 weeks.
When will I be able to return to sports, conditioning and recreation after the surgery?
Sports that require high contact and impact are not allowed until 6 months after surgery. Overhead activities that require throwing a ball are not allowed until 4 months after surgery.
