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Do You Need Rotator Cuff Surgery?

Many people live for several years without knowing they have a shoulder injury. Learn more about the different types of rotator cuff injuries. Find out when rotator cuff surgery is the best option.

The shoulder is one of the most critical, yet often overlooked joints in the human body. It plays a role in virtually all movements of the arm, whether you’re playing a game of catch or driving a car. The shoulder can also be affected by a wide range of painful conditions, including rotator cuff injury.

In this post we’ll discuss:

  • What is the rotator cuff?
  • Types of rotator cuff injuries
  • What are the symptoms of a rotator cuff injury?
  • Non-surgical options for rotator cuff repair
  • Who is the most likely candidate for rotator cuff surgery?
  • Types of rotator cuff surgery
  • Are there risks associated with rotator cuff repair?
  • Recovery from rotator cuff repair

What is the rotator cuff?

The rotator cuff surrounds the shoulder joint. It is responsible for keeping the upper arm bone firmly in place. It is a group of muscles and tendons that wraps over the head of the upper arm bone to hold it in the shallow shoulder socket.

Types of rotator cuff injury

Many different conditions can lead to the need for rotator cuff treatment. In some cases, rotator cuff surgery is the best option. These injuries include:

Tendinitis

Rotator cuff tendinitis is inflammation of the tendons that are used when your shoulder rotates. This inflammation is painful, especially when you raise your arms.

Inflammation is usually due to overuse, which is frequently seen in athletes. But any activity that involves frequently making overhead motion with the arms can lead to tendinitis. In some instances, it can be due to the buildup of calcium in the tendons.

Bursitis

Shoulder bursitis is also caused by inflammation. The bursa is a fluid-filled sac that helps your muscles glide across bone when you move.

When the bursa becomes inflamed, you experience shoulder pain. Bursitis is often commonly caused by overuse. In fact, tendinitis and bursitis often happen at the same time.

Torn rotator cuff

The most common condition that requires rotator cuff surgery is a tear. Rotator cuff tears can affect anyone and at any age, but are more likely as we grow older. Full rotator cuff tears can be caused by forceful injuries. Partial tears can be due to previous weakening of the rotator cuff through overuse or injury.

What are the symptoms of a rotator cuff injury?

Many symptoms can be associated with a rotator cuff injury. One of the most common is a

  • Dull ache deep within the shoulder.
  • Inability to sleep if lying on the injured shoulder.
  • Limited range of motion and arm weakness.

However, a study published in the Journal of Orthopaedics in March 2013 noted that often people who have rotator cuff tears without knowing it. 65.3% of the 664 participants in the study didn’t have symptoms.

Non-surgical options for rotator cuff repair

While rotator cuff surgery can offer help and healing, it is usually not the first course of treatment. What nonsurgical options are available to help heal a rotator cuff injury?

  • Rest: Rest can allow time for the inflammation to subside, reliving your pain. It may offer time for a partial tear to begin healing. Combine ice with rest, as well as the application of moist heat.
  • Physical Therapy: In some cases, physical therapy is used prior to surgery to reduce inflammation and improve range of motion. Physical therapy is also used after completing rotator cuff surgery for the same reasons.
  • Anti-Inflammatory Medicines: Your doctor may recommend using anti-inflammatory medicines. Ibuprofen or a similar medication will reduce the inflammation and pain.
  • Steroid Injections: Depending on the severity of your rotator cuff injury, steroid injections may be recommended.

If these treatment methods offer relief of your symptoms, and improve your range of movement and arm strength, you may not need rotator cuff surgery.

Who is the most likely candidate for rotator cuff surgery?

Not all patients will need rotator cuff surgery. Nonsurgical options are often exhausted prior to deciding to pursue surgery. Candidates for rotator cuff surgery typically have symptoms for at least six months. That is unless they have a very large tear. Significant loss of range of motion or weakness may also qualify you for surgery.

Types of Rotator Cuff Surgeries

If more conservative treatments are not successful in alleviating your symptoms, you may need rotator cuff surgery. Surgery may be the first option if the rotator cuff tear is particularly severe. There are several different types that may be performed.

Open vs arthroscopic

The rotator cuff can be operated on in two ways: open surgery or arthroscopy. Which one you experience depends on your condition and what it takes to fix it. Some large tears or complex injuries might require open surgeries. Your surgeon will tell you which is the best option for you.

Subacromial Smoothing

If your symptoms are due to degradation, damaged tendons, or similar issues, you may undergo subacromial smoothing. The surgeon will debride the joint to remove scar tissue and other debris.

Rotator Cuff Repair

In some instances, the rotator cuff is torn badly enough that it must be surgically repaired. The surgeon will debride the joint first, and then reconnect the torn tendons and reattach them to the bone.

Rotator cuff repair can be done both with open surgery and arthroscopy.

Are there risks associated with rotator cuff repair?

Yes, there are risks associated with rotator cuff surgery, as there are with any surgical procedure. Some of the most serious risks include bleeding and infection. In some instances, blood clots could form in the legs, or even in the lungs. There is also the chance that the surgery will not alleviate your symptoms, and you may not recover your full range of motion or previous strength.

Recovery from rotator cuff surgery

All surgical procedures will have some recovery time. Most patients will spend at least six weeks in a sling, being unable to move their arm to promote healing. You will also be prevented from driving for around a month. Most patients will need to go through at least some physical therapy after the sling has been removed.

 

Further reading:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3768248/#

https://www.uofmhealth.org/health-library/aa54545

http://www.orthop.washington.edu/?q=patient-care/articles/sports/arthroscopic-shoulder-surgery-for-the-treatment-of-rotator-cuff-tears

https://www.hopkinsmedicine.org/healthlibrary/test_procedures/orthopaedic/rotator_cuff_repair_92,P07682

https://orthoinfo.aaos.org/en/treatment/rotator-cuff-tears-surgical-treatment-options/

https://medlineplus.gov/ency/article/007207.htm

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