Rotator Cuff Repair
The rotator cuff is what keeps your arm bone in the shoulder socket. It’s made up of four tendons that attach the humerus (upper arm bone) to the scapula (in your upper back). The rotator cuff makes it possible for you to raise and lower your arm and rotate it in circles.
The rotator cuff tendons are key to the healthy functioning of the shoulder. They are subject to a lot of wear and tear, or degeneration, as we use our arms. Tearing of the rotator cuff tendons can be an especially painful injury. A torn rotator cuff sometimes creates a very weak shoulder. Most of the time, patients with torn rotator cuffs are in late middle age. But rotator cuffs tears can happen at any age–and to anyone whose shoulder goes through repetitive stress.
Rotator cuff tears can either be partial (incomplete) or full (complete).
Diagnosis & Treatment of Rotator Cuff Tears
Symptoms of a torn rotator cuff can include pain, weakness, and loss of motion. Many patients report that the pain occurs over the outside part of the shoulder but sometimes the pain can move down the arm towards the elbow or across the back of the shoulder. Sometimes the pain is so severe that it starts to interfere with your ability to get a good night’s sleep.
If your physician has diagnosed you with a torn rotator cuff you will most likely be referred to an orthopedic specialist for treatment. Diagnosis typically includes an MRI or other imaging that allows the doctor to see if there is a tear and whether it’s full or partial.
Non-Surgical Rotator Cuff Tear Treatments
While the torn tendons are not likely to heal on their own, there are treatment options before shoulder surgery is likely to be recommended.
The first step is typically controlling your pain and inflammation. Initial treatment may include one or more of the following:
- Anti-inflammatory medication
- Physical therapy
- Steroid injections
PRP and stem cell therapy
There have been recent advances in what are considered “orthobiologics” for treatment of painful rotator cuff tears. Partial tears that do not respond to other conservative treatments have been shown to benefit from PRP therapy. Please see more about orthobiologics here and here. Research into using stem cells to treat painful rotator cuff tears in ongoing. Currently, the most studied use of stem cells for treating rotator cuff tears is when stem cells are used at the same time as surgery to repair the torn rotator cuff tendons. The hope, however, is that new clinical trials may shed light on use of stem cells to treat complete tears without surgery.
Rotator Cuff Surgery
Orthopedic specialists will generally recommend rotator cuff surgery for a complete tear if you’re experiencing weakness or pain in the shoulder that is not improved by the non-surgical options.
The type of shoulder surgery recommended will depend on the severity and location of your tear, the tissue quality, and your individual anatomy. Today, however, it is much more common to repair tears of the rotator cuff using arthroscopic surgery versus an open surgery.
Surgery most often involves attaching the torn tendon(s) to the head of the humerus. Typically, is this done by using special devices called suture anchors that have been designed to attach tissue to bone.
As with PRP and stem cells, we are actively involved in research into other biologic options for treatment of rotator cuff tear. Regeneten is a bioinductive implant that acts as a patch over the tendon that helps tendons heal biologically through the induction of new tissue growth and can be used with partial and complete rotator cuff tear repairs. One advantage to this surgical augmentation is that recovery time is shortened.
Watch a Fully Torn Rotator Cuff Repair
Watch a Partially Torn Rotator Cuff Repair
There are times, however, when a rotator cuff tear may cannot be repaired. The tissue may be too damaged or damaged for too long that a repair is not possible. This is not an uncommon situation in older patients with rotator cuff tears. In some cases, a partial repair can be performed that eliminates most of the pain of these rotator cuff tears. A newer procedure called a superior capsular reconstruction may also be discussed.
Rehabilitation After Rotator Cuff Surgery
For those who choose to have surgery, rehabilitation after rotator cuff surgery can be a slow process. You will probably need to attend physical therapy sessions for two to three months, and most people can expect full recovery of range of motion and strength to take up to six months.
Arthritis after Rotator Cuff Tears
Patients who have a long standing lack of rotator cuff function can develop a condition called arthropathy (sometimes also called cuff tear arthropathy), which is a type of arthritis of the shoulder that develops when the rotator cuff is damaged. Developing this condition often results in shoulder pain, a reduction in strength and fluid movement of the shoulder, and difficulty stretching out the arm and/or raising it over the head. In cases of a rotator cuff tear and arthritis, a reverse shoulder replacement may be an option.
You can learn more about rotator cuff repair by downloading our educational documents A Patient’s Guide to Rotator Cuff Tears and A Patient’s Guide to Cuff (Rotator) Tear Arthropathy.