Rotator Cuff Injuries and Repair
Physicians see more rotator cuff injuries than almost any other musculoskeletal injury. A patient with a rotator cuff injury will experience pain and weakness in the shoulder, but not swelling. Sometimes the patient does not have symptoms. Usually, though, the patient will have increased weakness and pain when active. This is especially true when raising the arm higher than shoulder level. Fortunately, there are quite a few treatments available for rotator cuff injury. The type of treatment that is suitable would depend upon the patient’s age and the type of injury experienced.
There are two categories of rotator cuff injury. One is rotator cuff tendonitis. The other is rotator cuff tear. Be aware that there are several other conditions that could be the cause of shoulder pain. The only way to get an accurate diagnosis of rotator cuff injury is to see a doctor. He or she will first look at the symptoms and perform a basic physical examination. After this, the physician may use a local anesthetic that will be injected into the injured shoulder. This will help determine whether the injury is a muscle tear or tendonitis. If the injury seems to be a rotator cuff tear, the doctor may order some imaging tests. These will help confirm that the injury is a tear and isolate the location of the injury.
It is far more common for the diagnosis to be rotator cuff tendonitis; however, the treatment for tears is very similar to the treatment for tendonitis. Both can be treated conservatively with what is known as RICE therapy. That is: rest, ice, compression, and elevation. You may also want to use an over-the-counter pain medication like ibuprofen. Additionally, your doctor may give you a referral to a physical therapist to learn how to modify your movements and to get a list of exercises that may be beneficial to you. If your tendonitis pain persists, your doctor may give you injections of a steroid/anesthetic mixture. These would be administered to the joint to relieve pain.
This sort of non-surgical intervention usually has a 50-50 chance of being effective. If it is to work, you will probably see results in 6 – 12 weeks. Using non-invasive techniques of this sort can be good in a number of ways. When you do not have surgery, you also do not have recovery time. Furthermore, you do not experience any of the risks commonly associated with surgery such as complications caused by anesthesia, permanent stiffening of the joint, or infection. One thing to realize, however, is that this approach can cause the original tear to increase in size. Additionally, even though there is not a set recovery time, you will be operating at less than your usual ability until you have completely recovered. Aside from these considerations is the fact that non-invasive techniques may not be effective. You may end up having surgery after all. If your injury is quite severe, your doctor may bypass the non-invasive option and recommend surgery right from the start.
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When rotator cuff injury is treated with surgery, there are generally three options.
The first way is open repair surgery. When open repair surgery is chosen, the surgeon will make a full incision into the shoulder. This large incision has the potential of leaving a large scar; however, this method allows the surgeon to have a great deal of freedom of movement.
Another method that utilizes both an incision and arthroscopy is called mini-open repair surgery. This is an outpatient procedure in which the surgeon makes a smaller incision and uses an arthroscope to see the interior of the shoulder structure. This procedure leaves a much smaller scar.
All-arthroscopic surgery is the least invasive surgery. It is an outpatient procedure that leaves a very small scar.
The doctor will determine which procedure will work best based on the specific injury.
After rotator cuff surgery, most patients have decreased pain and an increase in range-of-motion. Recovery is usually complete within 4 to 6 months. Results are usually quite satisfactory, with 80 – 95% of patients reporting good results.
There are a number of things that will influence the outcome of your rotator cuff surgery. Foremost is the expertise of your surgeon. Aside from this, the type of injury you have experienced, the quality of the injured tissue, your age, and how well you follow your doctors orders will influence how well you recover.
Some patients experience complications from surgery; however, these are rare. One to two percent may experience nerve injury. Approximately one percent may contract infection. Less than one percent may have detachment of the deltoid muscle. Less than one percent may experience stiffness. Tendon re-tear is experienced by approximately six percent of patients.
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