The shoulder joint is highly complex. It is, in fact, one of the largest and most complicated joints in the human body. As such, injuries to this region can be difficult to treat and involve a lengthy recovery period. This is particularly true of rotator cuff injuries.
It is important to understand that not all rotator cuff injuries require surgery. Some minor or acute conditions can be treated via conservative measures, which involve outpatient rehabilitation as well as an at-home exercise routine.
Whether non-surgical treatment options will be successful in alleviating a person’s pain and restoring their function depend on a myriad of factors. These factors may include the following:
- The overall health and attitude of the patient
- Type and age of the rotator cuff tear: Is it an acute or chronic tear? Was it recently injured or is it a longstanding issue?
- Nature of the injury: Was the rotator cuff torn due to severe trauma, a sports-related injury, an orthopedic issue, or long-term wear-and-tear?
- Size and severity of the tear: Is it a complete or partial/incomplete tear? Are there multiple rotator cuff tears? Are the tendons still attached to the bone?
- Activity level of the patient: The more active and compliant the patient, the better the chances for a full recovery.
Nearly half of patients with rotator cuff injuries will find non-surgical treatment options to be effective at alleviating their pain and restoring their function.
For some individuals, however, severe pain may persist and their mobility will continue to be compromised. If they fail to make progress or the injury is more severe than originally anticipated, surgical intervention may be recommended. In cases of severe or complex shoulder trauma, surgery is often necessary.
Here are some of the common surgical options for rotator cuff tears.
1. Open Rotator Cuff Repair
This is the old-school and most invasive surgical application. It was used for decades before the advent of arthroscopic surgery. During this procedure, the surgeon makes a large incision over the shoulder and detaches the deltoid muscle to optimize their view of the surgical field as well as gain access to the damaged rotator cuff. This option is still used in cases of large or complex tears.
2. All-Arthroscopic Repair
This approach is much less invasive than the standard, open repair procedure. During this application, the surgeon utilizes an arthroscope, which is a small camera that is inserted into the shoulder joint via small incisions. This enables the doctor to use guided imagery to view the shoulder structures on a television screen and perform the necessary repairs. This option is considered to be the least invasive procedure for repairing rotator cuff injuries, and it involves the shortest recovery time.
3. Mini-Open Repair
This option uses arthroscopy to evaluate and repair other damaged structures within the shoulder joint. It allows the surgeon to repair the rotator cuff and view the shoulder structures directly, as opposed to using a video monitor.
4. Superior Capsule Reconstruction
Within the last five years, this new approach developed by Duke orthopedic surgeons has been utilized to repair severe and complex rotator cuff tears. During a superior capsule reconstruction, the surgeon attaches a human tissue graft to the patient’s affected shoulder socket and the other end to the patient’s upper-arm bone. The graft is intended to mimic the function of the rotator cuff tendon. Thus, it stabilizes the ball of the arm bone and keeps it centered in the shoulder socket as well as aids in arm movement.
If rotator cuff surgery is required, it is crucial that a patient looks after their interests, does their research, and discusses which options are best with their physician. Regardless of which approach an individual chooses, a positive attitude and focus will be beneficial to any patient headed for extensive rehabilitation. If you have a rotator cuff injury, contact Dr. Thomas Hackett for a consultation. To do so, call the office or fill out an online form.