Rotator Cuff Repair Health Article

Definition

Rotator cuff surgery is the repair of inflammation or tears of the rotator cuff tendons in the shoulder. There are four tendons in the rotator cuff, and these tendons are attached individually to the following muscles: teres minor, subscapularis, infraspinatus, and the supraspinatus. The tears and inflammation associated with rotator cuff injury occur in the region near where these tendon/muscle complexes attach to the humerus (upper arm) bone.

Purpose

Rotator cuff surgery is necessary when chronic shoulder pain associated with rotator cuff injury does not respond to conservative therapy such as rest, heat/ice application, or the use of non-steroidal anti-inflammatory drugs (NSAIDs). Rotator cuff injuries are often lumped into the category referred to as rotator cuff syndrome. Rotator cuff syndrome describes a range of symptoms from basic sprains and tendon swelling (tendonitis) to total rupture or tearing of the tendon.

Demographics

Approximately 5–10% of the general population is believed to have rotator cuff syndrome at a given time. It is not commonly found in individuals under the age of 20 years, even though many in this population are athletically active. In general, males are more likely than females to develop rotator cuff syndrome and require surgery. Most rotator cuff injuries are associated with athletic activities such as baseball, tennis, weight lifting, and swimming, where the arms are repeatedly lifted over the head. Rotator cuff injuries can also occur in accidents involving falling to the ground or when the humerus is pushed into the shoulder socket. Rotator cuff injuries can also occur in older, active individuals because the rotator cuff tendons begin to deteriorate after age 40. Occupations that have been associated with rotator cuff injuries include nursing, painting, carpentry, tree pruning, fruit picking, and grocery clerking.

Description

For most patients, if the pain begins to subside, they are encouraged to undergo a period of physical therapy. If the pain does not subside after a few weeks, then the physician may suggest the use of cortisone injections into the shoulder region. Rotator cuff repair is then considered if the more conservative methods are not successful.

The primary aim of rotator cuff repair is to repair the connection between the damaged tendon and the bone. Once this bridge is re-established and the connection between the tendon and the bone has thoroughly healed, the corresponding muscles can once again move the arm in a normal fashion. The goal of the surgery is to ensure the smooth movement of the rotator cuff tendons and bursa under the upper part of the shoulder blade. The surgery is also performed to improve the comfort of the patient and to normalize the function of the shoulder and arm. There are a variety of surgical approaches that can be used to accomplish rotator cuff repair. The most common approach is called the anterior acromioplasty approach. This approach allows for excellent access to the most common sites of tears—the biceps groove, anterior cuff, and the undersurface of the joint.

Most rotator cuff repairs are accomplished using incisions that minimize cosmetic changes in the skin following healing. If possible, the surgery is performed with an arthroscope to minimize cosmetic damage to the skin. Typically, the incision made is about the size of a buttonhole. The arthroscope, a pencil-sized instrument, is then inserted into the joint. The surgeon usually accesses the rotator cuff by opening part of the deltoid muscle. If bone spurs, adhesions, and damaged bursa are present in the rotator cuff region, then the surgeon will generally remove these damaged structures to improve function in the joint. In cases where the arthroscopic technique is not advised or when it fails to achieve the desired results, a conversion to open surgery is made. This involves a larger incision and usually requires more extensive anesthesia and a longer recovery period.

The success of the rotator cuff repair is dependent on the following factors:

• age of the patient
• type of surgical technique employed
• degree of damage present
• patient's recovery goals
• patient's ability to follow a physical therapy program following surgery
• smoking status
• number of previous cortisone injections