Rotator Cuff Tear

Rotator Cuff TearThe rotator cuff is a group of muscle which move the shoulder. The rotator cuff is made up of 4 muscles: the supraspinatus, the infraspinatus, the subscapularis and the teres minor.

Some patients with rotator cuff tears have no symptoms. Other patients complain of severe pain the shoulder. This often initially occurs with overhead activity, but eventually may become severe, especially at night. Rotator cuff tears typically occur in people greater tha 40 years old. Other than pain people with rotator cuff tears frequently notice weakness in the shoulder and occasionally cracking or grinding sensations (crepitation) in the shoulder.

The cause of rotator cuff tears is unknown, but is likley multifactorial including intrinsic degeneration of the tendon, poor potential for tendon healing, vascular insufficiency, repetitive trauma, and extrinsic mechanical pressure from the surrounding coracoacromial arch. There likely is an inherited predisposition to RTC disease as well.

The incidence of full thickness Rotator Cuff Tears increases with increasing age. In people under 60yrs of age the incidence of Rotator Cuff Tears is 6% as opposed to 30% in those over 60yrs of age. Some people with rotator cuff tears have no symptoms. The prevalence of asymptomatic tears is: 0% for age 40-49yrs old; 10% for 50-59; 20% for 60-69; 40.7% for >70yrs/old. Asymptomatic tears often eventually become symptomatic (painful).

Unrepaired Rotator Cuff Tears may progress and become irreparable. Long-standing tears may progress to muscle atrophy and fatty degeneration that compromises functional outcome after repair. Massive tears that are irreparable can also progress to a specific kind of arthritis known as rotator cuff arthropathy.

Treatment options for rotator cuff tears include both operative and non-operative treatments. Non-operative treatment consists of: activity modifications, non-steriodal antiinflammatory medications, moist heat, and a home based theraband strengthening exercise program/pulley ROM program. Physical therapy can often be benefical as well.

There are many surgical treatment options for rotator cuff tears. These include: shoulder arthroscopy with roRotator cuff anatomytator cuff repair and open rotator cuff repair as well as other treatments. Massive tears may be better treated with tendon transfers or reverse total shoulder arthroplasty. The surgery that is best for a specific patient varies depending on the type of rotator cuff tear that they have, patient age, medical co-morbidities, etc. Surgical treatment options and the risks and benefits of each procedure for a patient should be discussed with their orthopaedic surgeon.

In general risks of surgery for rotator cuff tears include but are not limited to: Recurrent tear, Hardware failure / Anchor pull-out, Acromion fx, Infection, Stiffness, CRPS, Nerve injury: Axillary nerve, Brachial plexus, Fluid Extravasation:, Chondrolysis, Hematoma, Chondral Injury / arthritis, Deltoid dehiscence (open repair), Anterior-superior instability / migration, Shoulder Pain, Shoulder stiffness, Incisional scar (cosmesis), DVT/PE and the risks of anesthesia including heart attack, stroke and death. Althought complications can occur most patients are satisfied with their surgical outcomes.

After surgery patients are typically placed in an abduction sling for 6 weeks. They may take it off to eat, shower, and to use the arm for desk work. Patients are also given a cold therapy device (cryotherapy) which deceases pain, improves sleep and decreases need for pain medication.

Patients should not smoke for 8 weeks prior to surgery and 8 weeks after surgery. Smoking greatly decreases the body's healing responses and patients who continue to smoke after surgery have poorer outcomes than those who quit smoking.

Patients generally start physical therapy 2-3 days after surgery.  Physical therapy proceeds through 4 phases. Phase 1: Passive Range of Motion (0 to 6 weeks). Phase 2: Active Range of Motion (6 to 12 weeks). Phase 3: Strengthening (10 to 16 weeks). Phase 4: Advanced Strengthening (16 to 22 weeks)

At 6-weeks patients may discontinue the sling, and begin overhead stretching exercises. Patients can not try to comb hair with the operated arm until six weeks post-op

Small/medium tears may generally play golf at 6 months post-operatively. Large/massive tears may play golf at 1 year

Small/medium tears may lift weights at 6 months. Large/massive tears may lift weights at 1 year

Further information about Rotator Cuff Tear can be found at the following sites:

Every person and their particular circumstances are different so the treatment for your shoulder may be different than those discussed above. Please read this information carefully. Write down any questions that you have about your injury and its treatment and discuss them with your orthopaedic surgeon.

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