Rotator Cuff Surgery Santa Rosa, CA
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.
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.
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:
1. Immobilization — 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 being to strengthen the surrounding muscles and improve range of motion. This will begin sometime 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.