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When Is Rotator Cuff Surgery Recommended?

When I come out form the ultrasound examination knowing I have a tear in my rotator cuff I was in panic and I literally started to cry to my friend on the phone. I had no idea what kind of treatment the orthopedist is going to determine for me.

I immediately started to think about the worst option, going through surgery. I’ve never been through a surgery before and I was terrified of the thought of possibly going through one. In the end it turned out all I needed was physiotherapy and exercises, and I was very glad to hear that.

Who Does Need to Go Through Surgery in Case of a Rotator Cuff Injury?

The decision whether one should go through surgery or not is based on a few factors:

  • The extant of the injury
  • The patient’s health
  • The patient’s age
  • The general function of the shoulder

Usually a Rotator Cuff Surgery is Recommended in These Cases

  • You feel a tearing sensation
  • You hear a popping sound from the shoulder during an activity
  • You don’t feel any improvement after going through non-surgical treatments such as medications, physical therapy etc.
  • You feel weakness in the shoulder that interferes with your lifestyle
  • You feel ongoing pain that interferes with your lifestyle

If you feel any of the described above you need to consult your doctor as soon as possible.

Full Thickness Rotator Cuff Tear

Rotator cuff tears are a fairly common cause of mild to severe shoulder pain. The chances of the shoulder rotator cuff getting damaged increases as a person ages. Mostly this issue is caused by tendon degeneration and not injury or trauma in most cases.

Surgeons don’t always recommend surgery for a full thickness rotator cuff tear. At first, non-surgical treatment is tried. If the rotator cuff muscle refuses to respond to nonsurgical methods, or if the tear is caused due to muscular weakness, or loss of function, surgery is immediately recommended.

The trial of non-surgical management is considered appropriate, as there is no evidence that treating the tear with surgery early on gives better results. Full thickness rotator cuff tears that are caused owing to profound weakness or those that are caused acute trauma are considered for early surgery. This is especially true if the full thickness rotator tear is more than 3 centimeters long.

The surgical treatment of a full thickness rotator cuff tear is meant to repair the tendon back to the ball of the shoulder joint from where it was torn. The surgeon’s choice of surgical method to fix this tear depends on many factors. One of these factors is the surgeon’s familiarity with a specific procedure and experience.

The second consideration would be the size of the tear, how good the tendon tissue or the bone is, and the patient’s ability to heal and so on. The commonly used surgical methods to fix full thickness rotator cuff tears are mini-open repair, open repair, and arthroscopic repair.

An individual surgeon’s ability to repair a torn rotator cuff and achieve a satisfactory result varies by technique. Variation is based on experience and familiarity with the technique. Although one surgeon may be capable of achieving a quality repair through all-arthroscopic means, another may have better results with mini-open repair. Prior to surgery, patients should discuss the options available to them with their surgeon. The surgeon can share results of using different techniques so that the most appropriate treatment plan can be designed.

Arthroscopic Rotator Cuff Surgery

During arthroscopic rotator cuff surgery, a patient is laid out in a half-seated position, with a support for the head. Usually general anesthesia is administered and the patient is wholly put to sleep. Sometimes, depending on the surgeon’s discretion, a local anesthetic is given in the shoulder to block the sensations leading to the arm attached to the shoulder. In the second case, the patient will be awake during the entire process but will not feel any pain. Since this causes the patient to feel stress, a mild sedative is given to put the patient in a state of calm while the arthroscopic rotator cuff surgery takes place.

Arthroscopic rotator cuff surgery can take anywhere between one to two hours. During this process, the surgeon uses several pen-shaped instruments with miniature video cameras attached to the end. A small incision in made in the shoulder of about 1 centimeter and a thin tube containing the video camera is inserted into this hole. The path taken by the camera is watched on a television screen and the surgeon performs the surgery with the remotely controlled instruments. Arthroscopic rotator cuff surgery uses small incisions that allow limited surgical access unlike the major incisions in open surgery. Patients recover from Arthroscopic rotator cuff surgery surgeries much faster as well.

Repairing a torn rotator cuff can be a complicated procedure, and that’s the reason open surgery is usually performed. However, arthroscopic rotator cuff surgery has become more common now for small tears in the rotator cuff and the results are good with minimal post-operative issues.

Arthroscopic Rotator Cuff Repair

It used to be that when a patient experienced a tear in a rotator cuff that called for surgical repair, the surgeon would make an incision of about 6-10 centimeters over the outside of the shoulder. Once the muscle was separated and the rotator cuff exposed, the rotator cuff would be inspected and repaired.  This procedure has been known as Open Rotator Cuff Repair.

However, this surgery comes with significant post-operative rehabilitation techniques that are painful and create a problem for the patient even after the rotator cuff tear is healed completely.  A recent arthroscopic rotator cuff repair technique using smaller incisions called the Mini Open Rotator Cuff Repair has become well known.

In this form of arthroscopic rotator cuff repair surgical technique, an arthroscopy is performed on the shoulder and the surgeon takes a good look at the joint and the cuff using a small camera and a television screen.  This arthroscopic rotator cuff repair technique is far more effective as the surgeon doesn’t have to cut in much into the shoulder. Most of the work is done using the arthroscope, which is the tiny camera and the small instruments. The actual incision might not be more than 3-4 centimeters, which heals a great deal faster.

Recently more techniques have been developed to use arthroscopic instruments to perform arthroscopic rotator cuff repair. Instead of the single 4-centimeter cut, surgeons make several small incisions of 1 centimeter each and work with smaller instruments while watching the whole procedure on a television monitor.

Surgeons have always looked for methods to minimize problems during and after arthroscopic rotator cuff repair surgery. With the new technique to perform arthroscopic rotator cuff repair, postoperative rehabilitation is also easier than before.

Rotator Cuff Operation

Rotator cuff operation is a surgical procedure that is undertaken to repair tears and severe injuries in the rotator cuff muscles of the shoulder joint. Injuries to the shoulder joint mostly mean injuries to one or more of the four rotator cuff muscles. If surgery is decided, then the type and severity of the rotator cuff operation depends on whether the rotator cuff muscle tear is of partial thickness or full thickness.

Even if only one of the four rotator cuff muscles is injured, the shoulder may or may not hurt much. This is because tendons don’t have nerves attached to them. If one muscle is injured, and the other three are still attached, the patient will be able to have relatively good function of the shoulder until degeneration starts.

These days, rotator cuff operation takes place arthroscopically.  Small incisions are made into the shoulder under a general anesthesia or a local nerve block. The surgeon uses tiny instruments at the end of which miniscule video cameras are attached. The surgeon is able to watch the path of the instruments via the cameras on a television screen. The surgeon locates the rotator cuff muscle tear and stitches it up using self-dissolving stitches. Once the rotator cuff operation is complete, the entire shoulder is wrapped up tight and a strong sling is applied with strict instructions not to move it.

The sling is supposed to be kept on for a couple of weeks after the rotator cuff operation for complete healing to take place. Open rotator cuff operations usually cause a lot of pain, which is now avoided by managing minor rotator cuff operations using arthroscopic techniques. If done properly, recovery should be quick and the patient should be able to resume normal activities within a few weeks.