A tear of the rotator cuff is a common injury in which the tendons are pulled off their insertion on the humerus. This often leads to pain and weakness in the shoulder and upper arm, requiring surgery to remedy. Treatments for rotator cuff tears vary widely depending upon the severity of symptoms and signs. An individual with a rotator cuff tear can have a sudden (acute/traumatic) or gradual (chronic) onset of shoulder pain with or without weakness. Although tears can occur as a result of a traumatic injury, many tears occur gradually and no specific injury can be recalled.
A complete rotator cuff tear will not heal. Complete ruptures usually require surgery to regain optimal function in the shoulder. The exception is 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.
There are a few options for repairing rotator cuff tears. Advancements in surgical techniques for rotator cuff repair include less-invasive procedures. Many of these surgical repairs can be done on an outpatient basis and do not require a stay in the hospital. Arthroscopic surgery is routinely used to repair rotator cuff tears. It is a minimally invasive procedure used to reattach rotator cuff tendon tears. The procedure is performed under general or regional anesthesia. The goal of the procedure is to reattach the tendon back to the arm, along with smoothing any bone spurs down. Orthopedic surgeons operate on the shoulder using small incisions, an arthroscope and small instruments. An arthroscope is a small, tube-shaped instrument that is inserted into a joint. It consists of a system of lenses, a small video camera and a light for viewing. The camera is connected to a monitoring system that allows the doctor to view the joint through a very small incision. The camera displays pictures on a television screen, and the surgeon uses these images to guide miniature surgical instruments to repair rotator cuff tears. Using these miniature surgical instruments, loose tendon fragments and other debris from the damaged tendon are removed in a process called debridement. The surgeon diagnoses the tissue damage to decide if more surgery is necessary.
The surgeon removes bone spurs from the bottom of the acromion and smooths out its surface in a procedure called subacromial decompression. This is done to prevent the acromion from impinging on the supraspinatus tendon, which can be very painful. After cleaning the area of the tendon where the tear is present and clearing an area on the humerus, the surgeon creates small holes in the humerus and places special tools called anchors into the holes to hold stitches in place. The surgeon then stitches the tear back together, and the tendon is reattached to the humerus by pulling the sutures against the anchors placed in the humerus. The incisions on the shoulder are closed and the patient’s arm may be placed in a sling. The procedure typically leads to a faster recovery time with less inflammation, discomfort and scarring than an open surgical approach.