What is a “Rotator Cuff”?
Your “rotator cuff” is a group of four muscles and their tendons that are responsible for keeping the shoulder joint stable and are called the: Supraspinatus, Infraspinaturs, Teres Minor, and Subscapularis. The rotator cuff is what helps raise and rotate the arm.
What causes a Rotator Cuff Tear?
The rotator cuff tendons have areas of very low blood supply. The more blood supply a tissue has, the better and faster it can repair and maintain itself. The areas of poor blood supply in the rotator cuff make these tendons especially vulnerable to degeneration from aging. Rotator cuff tears usually occur in areas of the tendon that had low blood supply to begin with and then were further weakened by degeneration.
This problem of degeneration may be accelerated by repeating the same types of shoulder motions. This can happen with overhand athletes, such as baseball pitchers. But even doing routine chores like cleaning windows, washing and waxing cars, or painting can cause the rotator cuff to fatigue from overuse.
Excessive force can tear weak rotator cuff tendons. This force can come from trying to catch a heavy falling object or lifting an extremely heavy object with the arm extended. The force can also be from a fall directly onto the shoulder.
Rotator cuff tears are called either “full thickness” or partial thickness,” depending on how severe they are.
- Full-thickness tears extend from the top to the bottom of a rotator cuff muscle/tendon.
- Partial-thickness tears affect at least some portion of a rotator cuff muscle/tendon, but do not extend all the way through.
What is a “Rotator Cuff Repair” Surgery?
A complete rotator cuff tear will not heal. Complete ruptures usually require surgery if your goal is to return your shoulder to optimal function. The exception is in elderly patients or patients who have other diseases that increase the risks of surgery. There is some evidence that repairing the rotator cuff within three months of the injury results in a better outcome. You will need to work with your surgeon to determine when is the best time to do the surgery.
Partial tears may not require surgical repair. If you have a partial tear, your surgeon will most likely want to give your rotator cuff a chance to heal on its own. But if you can’t stand the pain, or if you can’t use your arm, you may need to consider surgery.
There are different surgeries and the correct one will be determined by your surgeon, but the most common is an arthroscopic repair. Surgeons usually get excellent results using an arthroscope (mentioned earlier) to repair a torn rotator cuff. The first step involves careful removal of any unhealthy, degenerated rotator cuff tissue. Then, the area of the humerus bone where the tendon tore away is prepared for reattaching the tendon. To do this, the surgeon removes the soft tissue to form a raw bony area. Drill holes are made in the humerus for attaching sutures. The tendon is then sewn together and stitched to the humerus by looping sutures through the drill holes. The tendon heals to the bone over time, reattaching itself.
What to expect after Surgery?
The surgical procedure to repair a torn rotator cuff is sometimes the easiest and most straightforward aspect of treatment, and the rehab and recovery is the most challenging!
Day Of Surgery
Rotator cuff surgery is an outpatient procedure. Overnight stays in the hospital are generally unnecessary. The surgical procedure usually takes a few hours, depending on the extent of work needed to repair the torn tendons. After surgery, your arm will be placed into a sling. A sling that holds the arm slightly away from the side (an abduction sling) is generally recommended for rotator cuff repair surgery, as these hold the tendons in a more relaxed position. You will remain at the hospital until your pain is adequately controlled.
Phase I: Passive range of motion
Passive motion means the rotator cuff muscles and tendons are not doing any work. When the rotator cuff muscles contract, tension is placed on the repair that was performed. Passive motion means that the shoulder moves without placing tension on the repair. In order to perform passive motion, your therapist will move your shoulder for you. The therapist can also instruct you on how to move your own shoulder without contracting the rotator cuff muscles. This may last up to 6 weeks depending on the extent of the repair.
Phase II: Active range of motion
Active motion is initiated when there is sufficient healing of the tendons to allow them to start moving the arm, but before any extra resistance is applied. You may be limited to active motion for up to 12 weeks from the time of surgery. Active motion means that you can move your own arm, but not against resistance.
Phase III: Strengthening and Stabilizing
The strengthening phase of recovery is the most important. Because of the injury, surgery, and early phases of recovery, the muscles of the rotator cuff have become weak. Once the repair has adequately healed, it is important to begin strengthening the muscles to allow you to resume your normal activity level.