Rotator Cuff Repair Health Article

Diagnosis/Preparation

The diagnosis of rotator cuff injury is based on a combination of clinical signs and symptoms, coupled with diagnostic testing. The most common clinical signs and symptoms include:

• tenderness in the rotator cuff
• pain associated with the movement of the arm above the head

• pain that is fairly constant but more intense at night
• weakness or pain with the forward movement of the arm
• muscle atrophy in long-term injuries that involve a complete tendon tear

X rays are used to rule out other types of injuries or abnormalities present in the shoulder region. While x rays are often used to help solidify the diagnosis, arthrography, ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) are the definitive tests in the diagnosis of rotator cuff injury. Arthography and ultrasonography of the shoulder can help determine whether or not there is a full tear in the rotator cuff. A MRI can help determine whether there is a full tear, partial tear, chronic tendonitis, or other cause of the shoulder pain. The final decision to repair the tear ultimately rests on the amount of pain and restriction suffered by the patient.

Aftercare

Following the procedure, the patient will typically spend several hours in the recovery room. Generally, an ice pack will be applied to the affected shoulder joint for a period up to 48 hours. The patient will usually be given either prescription or non-prescription pain medication. The dressing is usually removed the day after surgery and is replaced by adhesive strips. The patient should contact a physician if there are any significant changes in the affected area once the patient goes home. These changes can include increased swelling, pain, bleeding, drainage in the affected area, nausea, vomiting, or signs of infection. Signs of infection include fever, dizziness, headache, and muscle aches.

It often takes several days for the arthroscopic puncture wounds to heal, and the joint usually takes several weeks to recover. Most patients can resume normal daily activities, with the permission of a physician, within a few days following the procedure. Most patients are advised to undergo a rehabilitation program that includes physical therapy. Such a program can facilitate recovery and improve the functioning of the joint in the future.

Risks

Complications following arthroscopic rotator cuff surgery are very rare. Such complications occur in less than 1% of cases. These complications include instrument breakage, blood vessel or nerve damage, blood vessel clots, infection, and inflammation. Complications, though still rare, are more common following open surgery. This is due to the larger incisions and more complicated anesthesia that is often necessary.

Normal results

The prognosis for the long-term relief from rotator cuff syndrome is good, especially when both conservative and surgical therapeutic approaches are used. In those patients who do require surgery, six weeks of physical therapy is typically instituted following surgery. Complete recovery following surgery may take several months. In rare cases, the rotator cuff injury is so severe that the patient may require muscle transfers and tendon grafts. Even more rarely, the injury can be so severe that the tendons are not repairable. This typically occurs when a severe rotator cuff injury is neglected for a long period of time.

Morbidity and mortality rates

Morbidity is rare in both the arthroscopic and open procedures. Mortality is exceedingly rare in patients undergoing rotator cuff repair.

Alternatives

Conservative approaches are typically used before surgery is considered in patients with rotator cuff injury. This is true even in cases where there is evidence of a full tendon tear. Some patients with a full or partial tear do not suffer a significant amount of pain and retain normal or nearly normal range of motion in shoulder movement. A majority of those with rotator cuff syndrome respond to conservative non-surgical approaches. Conservative therapies include the following:

• heat or ice to reduce pain and swelling
• cessation or reduction of activities that involve the movement of the arms overhead
• medication such as non-steroidal anti-inflammatory agents to reduce pain and inflammation
• cortisone injections to reduce pain and inflammation
• rest

Once the pain begins to subside, the patient usually is encouraged to begin a program of physical therapy to help re-institute normal motion and function to the shoulder.

BOOKS

Current Medical Diagnosis & Treatment. New York: McGraw-Hill, 2003.

"Rotator Cuff Tendinitis." In The Merck Manual, edited by Keryn A. G. Lane. West Point, PA: Merck & Co., 1999.

"Rotator Cuff Syndrome." In Ferri's Clinical Advisor, edited by Fred F. Ferri. St. Louis: Mosby, 2001.

Schwartz, Seymour I., ed. Principles of Surgery. New York: McGraw-Hill 1999.

Shannon, Joyce Brennfleck. Sports Injuries Sourcebook. Detroit: Omnigraphics, Inc., 2002.

PERIODICALS

Welling, Ken R. "Rotator Cuff Surgery." Surgical Technologist 31 (1999): 4.

Mark Mitchell