Rotator Cuff Surgery Santa Rosa, CA
What is a rotator cuff tear?
A rotator cuff is a group of four muscles and tendons that connect the upper arm, the humerus, to the shoulder blade, the scapula and allow the shoulder to move. The job of the rotator cuff is to keep the ball of the humerus in the center of the shoulder joint.
When one of the rotator cuff tendons tears, the tendon is either completely or partially detached from the head of the humerus. The supraspinatus tendon is the most common location for rotator cuff tears. There are different degrees of rotator cuff damage:
- Grade 1 — This is a strain, without a tear. The fibers have been stretched.
- Grade 2 — This is a partial tear, but the tendon is not completely severed.
- Grade 3 — This is a full-thickness tear that creates a hole through the tendon, splitting the soft tissue into two pieces.
What causes a rotator cuff tear?
It’s common to think that a rotator cuff tear is the result of violent motion, such as throwing a hard curveball. This type of acute injury is common, as are tears resulting from a fall where the person extended an arm or fell directly onto the shoulder. Shoulder dislocations commonly tear the rotator cuff. Certain rapid force movements when lifting heavy weight can also tear these tendons.
However, plenty of these tears are simply a result of normal age-related wear and tear leading to a degeneration of the tendon. There can be different reasons for the degenerative of the rotator cuff tendons that led to the tear:
- Repetitive use — Many sports, such as tennis or volleyball, require repetitive shoulder motions with the arm above the person’s head. The same can be true with occupations such as carpentry or painting. These movements stress the rotator cuff.
- Age — These injuries are most common in people over the age of 40. This is due to the blood supply. When we’re younger, blood easily accesses the area and slight tendon tears repair themselves. With age, circulation efficiency declines, so the blood cannot perform the same repair function.
- Weak muscles and poor posture — Sedentary lifestyles and slumping posture increase the odds of these tears.
- Arthritis — In arthritis sufferers, bone spurs develop on the underside of the acromion bone, and when the arm is lifted these spurs rub on the supraspinatus tendon, weakening it over time.
Does a rotator cuff tear always need surgery?
People have some misconceptions about the rotator cuff tears and injuries. Once there is a tear in one of the tendons it will not heal itself. A grade 1 strain can heal itself, but a tear will not. But that doesn’t mean surgery is always required. Patients may want to avoid surgery, and there are treatments that can relieve the pain and improve function. The problem with these treatments, however, is that the shoulder will not strengthen again. It is also possible to turn a minor tear into a major tear by continuing to use the shoulder. This often occurs if the patient opts to not have surgery, but continues playing the sport or producing the repetitive motions that initially caused the damage. At Redwood Orthopaedic Surgery Associates, we perform rotator cuff surgery for patients in Santa Rosa, CA and the surrounding area.
If a patient wants to avoid surgery, at least for a period of time, these are the possible treatments for a torn rotator cuff:
- Rest. This includes limiting any overhead activities and not raising your arm above your shoulder. If serving and spiking the ball when playing volleyball is your problem, you’ll have to stop playing. Same with swimming or playing baseball or softball.
- Non-steroidal anti-inflammatory medicine. Ibuprofen and naproxen reduce pain and swelling.
- Strengthening exercises and physical therapy. Strengthening the muscles that support the shoulder can restore movement and help with flexibility.
- Steroid injections. Cortisone injections are effective anti-inflammatory medicine and will eliminate pain, but there is some thought they may also weaken the tendons. This is not a long-term solution.
What are the benefits of having surgery to repair the rotator cuff?
We often see patients at our Santa Rosa offices that are having difficulty sleeping due to pain in their shoulder. They find that reaching into a cabinet to retrieve a plate has become untenable with their injured shoulder. They’ve had to stop playing a sport they love, such as tennis, because of their shoulder.
Reversing these issues is the goal and obvious benefit of surgery. While these are not simple surgeries to recover from, they are very effective at repairing the damage and returning the patient to full activity with their repaired shoulder.
We’ll discuss your options, obviously, but the choice between having surgery and not really comes down to whether you want full use of your injured shoulder or if you’re OK being limited on that side.
Who is a candidate for rotator cuff surgery?
As mentioned above, in many cases patients opt to manage their torn tendon and live with it. In these instances, a good candidate for surgery would one who has tried to manage but has found they are having more difficulty than they imagined or if they want to return to the sports and activities they have had to opt-out of.
But there are times when surgery will be necessary. We will recommend surgery if you have persistent pain or weakness in your shoulder that is not improving with physical therapy and other options. This usually comes after months of anti-inflammatory medication and limiting the use of the arm. If your job depends on being able to work over your head, this is a necessary procedure. The same is true for participants in sports who do not want to give them up.
How will I know if I need rotator cuff surgery?
The choice for surgery is usually not cut and dry. Sure, if there is a full tear as a result of a shoulder dislocation or other trauma, you’ll need surgery. But in other cases, there is a lot of grey area in the decision. If the conservative treatments above don’t seem to be having an effect and you’re dealing with pain when sleeping and doing routine, mundane tasks, it could be time to consider surgery with the team at Redwood Orthopaedic Surgery. Or, if your livelihood is at stake — if you’re a carpenter, for instance — you’ll need surgery to rebuild the strength you need in your shoulder.
These would be situations where we would likely recommend surgery:
- You have a large tear (over 3 mm)
- Your tear was caused by an acute injury
- You have a significant amount of weakness
- You have lost function in areas where you cannot tolerate it
- You have had significant pain for over six months
At Redwood Orthopaedic Surgery Associates, we use different methods to repair rotator cuff tears. These may involve open surgery, arthroscopic methods, or a hybrid of the two. Whenever possible, we use arthroscopic options because they cause less trauma and make for easier recovery.
- Open repair
If your injury involves a large or complex tear, or if you require additional reconstruction such as a tendon transfer, this will likely merit open surgery with an incision stretching several centimeters. The incision is made over the shoulder and the deltoid muscle is detached to gain access to the rotator cuff. During open surgery, we will also remove any bone spurs from under the acromion to minimize future rubbing on the tendon. If needed to gain more space for the rotator cuff, we may even remove part of the acromion.
- All-arthroscopic repair
In an all-arthroscopic procedure, we insert a small camera, an arthroscope, into the shoulder joint through a very small incision. The camera provides visuals of the area without the need for a large incision. Since miniature surgical instruments are also used, this surgical option is the least invasive.
- Mini-open repair
This procedure is a hybrid of open and arthroscopic methods. Here we use arthroscopy to assess and treat damage to other structures within the joint, issues such as bone spurs. Then, through the mini-open incision, usually 3 to 5 cm long, we will directly view and repair the rotator cuff. In the mini-open method the deltoid muscle is not detached.
Can a rotator cuff tear heal without surgery?
There is some misconception here. Torn rotator cuff tendons will not heal themselves. A sprained tendon can heal, as it has only been over-stretched. Still, many patients at Redwood Orthopaedic Surgery opt to not have surgery. They can use anti-inflammatory medication, steroid injections, and physical therapy to live with the injury, and they may be able to strengthen the muscles in the shoulder to retain good function.
But if you are active and use your arm for overhead work or for sports then it’s more likely surgery will be recommended.
Is rotator cuff surgery painful?
As you would expect, the surgery itself is not painful. You will be under general anesthesia. You will have some pain in recovery, both during the immobilization phase that lasts 4 to 6 weeks and during your rehabilitation. This is normal. Initially, your repaired shoulder will be quite stiff, as it has not moved for at least one month. Overcoming this stiffness is the first goal of your physical therapy. From there, increasing range of motion is next.
This isn’t usually acute pain, but simply a result of pushing your repaired shoulder to regain function. It’s important to not do too much therapy, but too little is no good either. Compared to the pain you had with your injured shoulder, this pain is far easier to manage.
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What are the potential risks with rotator cuff surgery?
This is a major surgery where your Redwood Orthopaedic surgeon has had to sew your tendons back to your upper arm bone. This entails all of the risks with any surgery: excessive bleeding, reaction to anesthesia, infection, poor wound healing, and the like. There is also the possibility of nerve injury and deltoid detachment in open rotator cuff surgeries.
The main risk with rotator cuff surgery is that the patient re-tears the tendon or tendons. The success of healing in these surgeries is directly related to the size of the tear. Small full-thickness tears the size of a fingernail heal fully in 95 percent of cases. As the size of the tear increases, the chances of re-tearing the tendon increase. This is because the hole in the torn tendon can sometimes be too large to be filled by stretching the remaining tendon across it.
What is recovery like after rotator cuff surgery?
Your recovery will be dictated to a degree by which method was used for your surgery. Regardless of the method, we use, however, this is not a simple, quick recovery. Our entire team at Redwood Orthopaedic Surgery Associates is with you through this entire process to ensure your best final outcome.
With the open method, you’ll likely spend at least one night in the hospital. Once home, there are no shortcuts here if you want a successful end result. Your dedication to rehabilitation will directly impact your return of motion and function in your repaired shoulder. Your rehabilitation will involve three steps:
- This first phase is meant to protect your surgically repaired tendon. You will wear a sling to keep your arm from moving, and will not be able to use it. The length of this phase depends on the severity of your tear but will last from 4 to 6 weeks.
2. Passive exercise
- A physical therapist will help with this second phase, the goal is to strengthen the surrounding muscles and improve range of motion. This will begin some time within the first 4 to 6 weeks after surgery. The therapist will generally support your arm, moving it in the desired directions.
3. Active exercise
- After 4 to 6 weeks, you will begin active exercises under the guidance of a therapist. Then at 8 to 12 weeks, you will shift to strengthening exercises.
Full recovery can take up to one year, with adequate strength and function coming somewhere between 4 to 6 months after surgery. It is important not to rush things with your recovery.