Rotator Cuff Tears: Treatment Options

Rotator Cuff Tears: Treatment Options

The rotator cuff functions both to stabilize and mobilize the shoulder joint. A rotator cuff tear may result in pain, weakness, and even decreased motion that can impact a patient's day-to-day activities. Left untreated, it is hard to determine whether a rotator cuff tear will progress. Sometimes, if a tear is not addressed for years, not only may the tear enlarge in size, but there may be changes to the cartilage, which is the smooth covering on the ends of our bones that allows for our joints to have smooth and pain-free movement. These changes are referred to as rotator cuff arthropathy, which is a type of wear and tear arthritis.

There are many factors for the doctor to consider for each patient when it comes to nonoperative versus operative treatment of a rotator cuff tear. Two of these factors include depth of the tear or size of the tear. Depth can be broken down into partial thickness versus a full-thickness tear. The size of the tear can range from small, medium, and large to even massive-sized tears. In addition to size and depth, the surgeon will also consider the health of the patient, symptoms, location of the tear, and if there are any other ongoing conditions in the shoulder joint.

For patients who are candidates for a trial of nonoperative treatment, these may include activity modification, physical therapy, nonsteroidal anti-inflammatory medications, and possible therapeutic injections. For those who are not candidates or did not benefit from nonoperative management, surgery will be considered. Surgically, a rotator cuff tear can be addressed in several ways. It can be repaired through a mini-open incision or through a minimally invasive technique referred to as arthroscopic surgery, where the surgeon will use a camera called an arthroscope and small instruments via mini incisions called portals.

Sometimes, a tear may be so large the surgeon may not be able to fix it with a standard repair. In these cases, there are other procedures a surgeon may perform to help treat the patient. For the purpose of this video, we will focus on what to expect with an arthroscopic rotator cuff repair. On the day of surgery, the patient will be positioned in one of two different ways, depending on the surgeon's preference. One position is referred to as the beach chair position, where the patient is seated upright with the upper body reclined back slightly. The other position is referred to as the lateral decubitus position, where the patient will be lying on their side with the affected shoulder facing up. Both positions allow for the surgeons to visualize the inside of the shoulder joint using an arm positioning device.

After the surgeon has evaluated the rest of the shoulder joint, they will focus on repairing the rotator cuff. They will have their camera positioned in an incision at the back of the shoulder to view the tear. Here, they will reassess the size, depth, and pattern of the tear. This helps the surgeon determine what kind of repair is most appropriate to perform. After surgery is complete, recovery begins. Postoperative recovery will be specific to the patient and depend on several factors. Generally, patients will wear a sling at first to protect and support their shoulder. They will perform gentle motion exercises of the hand, wrist, and elbow to prevent stiffness of these joints while in the sling. The surgeon will then release the patient to start working on regaining motion. Strengthening is then gradually incorporated and tailored to the patient's goals so they may return to their favorite activities.