Rotator Cuff Injuries and Repair
Rotator Cuff Injuries and Repair
by Dr. Richard Edelson
Physicians see more rotator cuff injuries than almost any other musculoskeletal injury. A patient with a rotator cuff injury will experience pain and weakness in the shoulder, but not swelling. Sometimes the patient does not have symptoms. Usually, though, the patient will have increased weakness and pain when active. This is especially true when raising the arm higher than shoulder level. Fortunately, there are quite a few treatments available for rotator cuff injury. The type of treatment that is suitable would depend upon the patient's age and the type of injury experienced.
Rotator cuff injuries occur in two ways. You could either have rotator cuff tendonitis or a rotator cuff tear. It is important to realize that there are a few other conditions that can cause the type of pain one experiences with a rotator cuff injury. For an accurate diagnosis, you will need to see your physician. The first step your physician will take is a physical examination. Following the examination, your doctor may inject your injured shoulder with a local anesthetic. This process will help your doctor in determining exactly what kind of injury you have. If your doctor decides that you have a rotator cuff tear, he or she may send you for some imaging tests. Imaging tests will help pinpoint the location of the injury and confirm whether or not the injury is a tear.
Rotator cuff tendonitis is more common than rotator cuff tear, but the treatment is similar for both. Rest, ice, compression and elevation, also known as RICE therapy, is prescribed for both conditions. Your doctor may also tell you to take an over-the-counter pain medication like ibuprofen. You may also be referred to a physical therapist who will help you to understand how to modify your activities to avoid pain and may also give you instructions on exercises to help strengthen your shoulder. If these measures dont help, your doctor may give you a shot of a steroid/anesthetic mix. This injection will be made directly into the joint to help address your pain.
This sort of non-surgical intervention usually has a 50-50 chance of being effective. If it is to work, you will probably see results in 6 - 12 weeks. Using non-invasive techniques of this sort can be good in a number of ways. When you do not have surgery, you also do not have recovery time. Furthermore, you do not experience any of the risks commonly associated with surgery such as complications caused by anesthesia, permanent stiffening of the joint, or infection. One thing to realize, however, is that this approach can cause the original tear to increase in size. Additionally, even though there is not a set recovery time, you will be operating at less than your usual ability until you have completely recovered. Aside from these considerations is the fact that non-invasive techniques may not be effective. You may end up having surgery after all. If your injury is quite severe, your doctor may bypass the non-invasive option and recommend surgery right from the start.
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There are three ways to treat a rotator cuff injury surgically:
The first way is open repair surgery. When open repair surgery is chosen, the surgeon will make a full incision into the shoulder. This large incision has the potential of leaving a large scar; however, this method allows the surgeon to have a great deal of freedom of movement.
2. Mini-open repair surgery: This method is like open repair surgery, but it also utilizes arthroscopy. The advantages of this method are that it is an outpatient procedure that leaves a smaller scar.
All-arthroscopic surgery is the least invasive surgery. It is an outpatient procedure that leaves a very small scar.
After examining and diagnosing your injury, your doctor will be able to make a sound decision as to which method will work best for you.
After rotator cuff surgery, most patients have decreased pain and an increase in range-of-motion. Recovery is usually complete within 4 to 6 months. Results are usually quite satisfactory, with 80 - 95% of patients reporting good results.
The expertise of the surgeon is a very important factor in the successful outcome of the surgery. However, there are some variables to keep in mind when considering speed and success of recovery. Among them are the type of tear, tissue quality, the patients age, and the amount the patient complies with the doctors instructions.
It is rare to experience complications with rotator cuff surgery. Tendon re-tear, which is the most commonly experienced complication, only occurs in about 6% of patients. One or two percent may have nerve injury. As little as one percent of patients may contract infection. Detachment of the deltoid muscle and/or stiffness are experienced by fewer than one percent of patients.
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