When should you have your rotator cuff tear surgically repaired?
I will attempt to distill the complicated clinical decision of when to surgically repair your rotator cuff tear into a short post based on current knowledge.
The rotator cuff is a group of 4 muscles and tendons in your shoulder that helps to stabilize the shoulder and to internally and externally rotate as well as abduct and the shoulder. It can be injured with many types of trauma to the area, as well as overuse and degeneration of the cuff muscles and tendons and/or surrounding structures over time.
The indications for surgery include: 1) Acute loss of strength due to rotator cuff tear with healthy muscle bellies. 2) After failure of non-operative rehabilitation treatment and modalities for a chronic tear for 3-6 months.
What are the contraindications to getting the shoulder repaired? Tears causing no pain or decrease in function, frozen shoulder, or chronic “massive” irreparable tears should not be surgically repaired. In addition, a surgeon may be unwilling to repair it if it is a chronic tear with little pain, longstanding weakness, or if the chief complaint is poor function.
With younger patients with rotator cuff pathology, the inherent quality of the muscle and tendon complex can be better, thus prompting many surgeons to surgically repair a tear in young people earlier.
The highly simplified goals of surgery are to cut out the tear margins, especially if it is frayed and degenerative, free up the cuff tear from any scar tissue that has formed, reattach the tendon to bone if necessary, and repair the tendon itself. The eventual goal is increased function and strength of the shoulder, decreased or resolved pain, and maintenance of as much safe range of motion as possible.
The surgeon may decide to operate with an arthroscopic approach using tiny cameras and instruments through tiny holes to repair the tear, or he/she may opt for a mini-open or a full open procedure. The approach varies depending on the tear, patient and surgeon. You must talk with the surgeon about which will be best for you.
The exact timing can be tricky. You should balance your personal life and obligations with when is optimal to give the cuff the best chance for healing. Typically, after the surgery, you will asked to not lift anything heavier than a cup of coffee for about 3 months although early passive range of motion and rehabilitation exercises will be incorporated. As a result, most people need someone at home to help them with their activities of daily living, driving, and shopping.
The bottom line is that if you think you have torn your rotator cuff, immediately see a sports medicine physician or orthopaedist to determine if you have indeed torn your cuff and if non-operative rehabilitation or surgery is the best option for you.
September 28th, 2009 at 3:23 pm
Thanks for the info Dr. Paul,
My mom was in a bus accident last August. The accident caused small tears in the muscles and tendons in her left shoulder. The pain is mild to moderate, but they have been bothering her for over a year. She had physical therapy but her range is still very limited. Her doctor said he’ll do surgery if she can’t stand the pain. Right now she’s just on pain meds as needed.
Do you have recommendations for types of excercise that would help recovery, reduce pain, or increase her range of motion? Thanks!