Rotator Cuff Repair

The rotator cuff is the network of four muscles and several tendons that form a covering around the top of the upper arm bone (humerus). These muscles form a cover around the head of the humerus. The rotator cuff holds the humerus in place in the shoulder joint and enables the arm to rotate.

Rotator cuff tear is a common cause of pain and disability among adults. Most tears occur in the supraspinatus muscle, but other parts of the cuff may be involved

The rotator cuff can be torn from a single traumatic injury. Patients often report recurrent shoulder pain for several months and a specific injury that triggered the onset of the pain. A cuff tear may also happen at the same time as another injury to the shoulder, such as a fracture or dislocation.

Most tears, however, are the result of overuse of these muscles and tendons over a period of years. People who are especially at risk for overuse are those who engage in repetitive overhead motions. These include activities such as baseball, tennis, weight lifting, and rowing.

If nonsurgical treatment does not relieve symptoms the surgery is advised. The type of surgery depends on the size, shape, and location of the tear. A partial tear may require only a trimming or smoothing procedure, called a "debridement". A complete tear within the thickest part of the tendon is repaired by suturing the two sides of the tendon back together. If the tendon is torn away from where it inserts into the bone of the arm (humerus), it is repaired directly to bone.

During your Rotator Cuff Repair surgery, the surgeon may remove part of the front portion of the scapula, the acromion as part of the procedure. The acromion is thought to cause "impingement" on the tendon. This may lead to a tear. Other conditions such as arthritis of the AC joint or tearing of the biceps tendon may also be addressed.

In general, there are three approaches for surgical repair. These include:

Arthroscopic Repair: A fiberoptic scope and small, pencil-sized instruments are inserted through small incisions instead of a large incision. The arthroscope is connected to a television monitor and the surgeon can perform the repair under video control.
Mini-Open Repair: Newer techniques and instruments allow surgeons to perform a complete rotator cuff repair through a small incision, typically 4 cm to 6 cm.
Open Surgical Repair: If the tear is large or complex or if additional reconstruction, such as a tendon transfer, has to be done. In some severe cases, where arthritis has developed, one option is to replace the shoulder joint.

After surgery, the arm is immobilized to allow the tear to heal. The length of immobilization depends upon the severity of the tear. An exercise program will help regain motion and strength in the shoulder.

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