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Published: Sunday, 9/12/2010

Rotator cuff symptoms and surgical treatment

BY CHRIS FOETISCH, M.D.
SPECIAL TO THE BLADE

This is one of a series of columns about health issues written about staff members of ProMedica, Mercy Health Partners, and the Toledo Clinic.

Pain, loss of motion, and weakness may occur when one of the rotator cuff tendons tear.

The pain can range from mildly annoying to severe, affecting sleep and normal activities. People usually will complain of pain over the top of the shoulder and arm.

In some patients, the pain can descend down the outside of the arm all the way to the elbow. The other common symptom of a rotator cuff tear is weakness of the shoulder.

Weakness causes difficulty lifting the arm up overhead or difficulty with activities such as reaching, getting dressed, or carrying objects.

Most rotator cuff tears occur through normal wear and tear. Some occur as result of an injury such as a fall. Rotator cuff tears are a common source of shoulder pain. The incidence of rotator cuff damage increases with age. The highest incidence occurs in individuals who are older than 60 years.

What is the rotator cuff?

The rotator cuff is a group of four muscles that surround the ball of the shoulder joint.

The muscles function to provide rotation, elevate the arm, and give stability to the shoulder joint.

The supraspinatus most frequently is involved in degenerative tears of the rotator cuff. More than one tendon can be involved if the tear has been present for a long time or after a severe injury.

There is a bursa (sac) between the rotator cuff and acromion that allows the muscles to glide freely when moving. When rotator cuff tendons are injured or damaged, this bursa often becomes inflamed and painful.

What is the treatment?

Nonsurgical treatment typically involves avoidance of activities that cause symptoms. Physical therapy and injections also can be helpful. Nonsurgical management of a rotator cuff tear can provide relief in approximately 50 percent of individuals.

Surgical management is indicated for a rotator cuff tear that does not respond to nonoperative management and is associated with weakness, loss of function, and significant pain.

The main reason to consider rotator cuff surgery is for pain relief.

Surgical treatment of a torn rotator cuff is designed to repair the tendon back to the ball of the shoulder joint from where it is torn. The surgery can be performed as an open repair through an incision or athroscopically through several small holes.

Less invasive

Surgical techniques for rotator cuff repair have progressed to more minimally invasive procedures.

The most recent development is the all-arthroscopic technique. Each step toward less invasive surgery has benefited the patient by decreasing pain from surgery, decreasing postoperative stiffness, decreasing surgical blood loss, and decreasing the length of stay in the hospital. Most arthroscopic rotator cuff repairs are done as an outpatient. Additionally, athroscopic surgery has the benefit of finding and fixing other problems that cannot be identified through an open repair.

Expectations

Most people will be in a sling from two to six weeks depending on the size of the tear and difficulty of the repair. Typically, there is a course of physical therapy to help restore range of motion, function, and strength.

A complete recovery can take up to six months and larger tears may take longer. Most people are able to resume normal activities between three and four months. After rotator cuff repair, 80 percent to 95 percent of patients achieve a satisfactory result, defined as adequate pain relief, restoration or improvement of function, improvement in range of motion, and patient satisfaction with the procedure. Certain factors may decrease the likelihood of a satisfactory result such as poor tissue quality, large tears, poor compliance with postoperative rehabilitation and restrictions, and patient age older than 65 years.

Dr. Foetisch specializes in orthopedic surgery, with a practice emphasis involving the shoulder and knee.



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