Rotator Cuff Repair

Rotator cuff repair can be done by either conservative or surgical means. Both have their own advantages and disadvantages.

Conservative Management

Conservative management is recommended for people who suffer from shoulder pain alone without any decrease in shoulder strength.

1. Avoiding pain inducing activities
2. Perform shoulder pain exercises
3. Injections

For advice on shoulder exercises, go to my Exercises After Shoulder Surgery page.

Injections that are used are usually corticosteroids with or without local anesthetics. They decrease pain and swelling in the injected area. This results in decreased pain and stiffness. But the improvement is temporary, usually lasting for a month or so. Moreover, side effects like infection, worsening pain immediately following injection lasting for a day or two and atrophy of the skin can occur.

Avoiding pain-inducing activities in the shoulder joint is without any side effects but it can itself predispose to increasing stiffness and frozen shoulder.

Shoulder pain exercises are usually the best conservative option, but the level of success will depend upon the amount of arthritis present under the acromioclavicular joint of the shoulder.

Surgical Management

Surgery is sometimes necessary for rotator cuff tears associated with decrease in strength of the affected shoulder joint. There are three types of surgical repair

1. Open repair
2. Mini open repair
3. Arthroscopic repair

All of the above methods give more or less equal improvement in pain, functional level and patient satisfaction. The choice of the procedure actually depends upon the proficiency of the surgeon, anatomy of the involved area and cosmetic consideration of the patient.

OPEN ROTATOR CUFF REPAIR

Here an incision of several centimeters long is made over the shoulder joint. The deltoid muscle, which covers the shoulder joint, is exposed. It is then cut to gain access to the tear. Reattaching the torn rotator cuff tendon to the bone closes the tear. Any bony fragments or spurs in the underside of the acromion process of the scapula are also removed during the procedure. The deltoid muscle is again sutured together. Then the tissues under the skin, and finally the skin are closed.

In open surgery, no arthroscopic instrument is used during the procedure.

MINI OPEN ROTATOR CUFF REPAIR

Technically, it is in-between the open and arthroscopic rotator cuff repair. Here the incision is only about 4 cm long. The deltoid muscle is not cut open in this method. Instead, an arthroscope is used to assess the damage and remove the bony fragments of spurs in the underside of the acromion. Subsequently, the torn rotator cuff tendon is reattached to the humeral head. The incision is then closed in layers.

ARTHROSCOPIC ROTATOR CUFF REPAIR

Here the surgery is done through multiple small cuts around the shoulder. Flexible wires called portals are introduced through them. They contain a light source and camera, which enable the surgeon to see and assess the damage. Removal of spurs from the underside of the acromion and repair of the rotator cuff tear are done through the portals themselves using flexible wires capable of carrying various cutting and suturing instruments within themselves in to the joint. This procedure requires a highly proficient and experienced orthopedic surgeon.

The postoperative pain, stiffness, recovery and rehabilitation are comparatively better with arthroscopic. But open and mini open surgeries provide assured and long term results, especially if the initial rotator cuff tear is very large.

For more on exercises after shoulder rotator cuff repair surgery, click here.