Monday, April 4, 2016

Rotator Cuff Repair

The rotator cuff consists of four muscles that surround the ball and socket joint in the shoulder. Their

role is to initiate shoulder movement and to stabilize the joint by compressing the ball against the socket when larger muscles such as the deltoid, trapezius, and latissimus are recruited to perform heavy lifting or overhead activities such as those in tennis or baseball. Overuse and acute traumatic injuries can cause a tear in one or more of the tendons that attach the rotator cuff muscles to the bone on the ball of the shoulder. This is a common injury seen in orthopedic sports medicine clinics. The patient that presents with a rotator cuff tear typically will describe pain or inability to use their arm
away from their body. This includes reaching overhead, reaching away from their body and reaching behind the back. Physical examination will often demonstrate weakness in muscle testing of the rotator cuff. X-rays are most often normal. An MRI or an ultrasound test can be used to determine if a rotator cuff tear is present.

Depending on the individual surgery or nonoperative management may be an option. Chronic tears with a gradual onset can frequently be managed by physical therapy as we demonstrated in our MOON Shoulder study where 85% of patients over 50 years old with chronic tears were successfully managed for a minimum of a year without surgery. Future blogs will discuss this study further, but it can be found here. MOON Shoulder Study It appears that surgery is more routinely indicated in a couple of circumstances: 1.) tears in individuals less than 50 years old and 2.) acute tears with no previous history of a full thickness tear. This is somewhat controversial and strict indications for rotator cuff repair are difficult to tease out of the medical literature as Brian Wolf, Warren Dunn and I found when we performed a review on the topic in the American Journal of Sports medicine. Rotator Cuff Repair Indications 

Surgical repair involves typically an arthroscopic approach utilizing small puncture wounds where small minimally invasive instruments are used to reattach the torn rotator cuff tendon. This is done by placing anchors with sutures into the bone and stitching the tendon in place. Physical Therapy begins shortly after surgery and continues 3-4 months until strength and motion have been regained.

1 comment:

  1. Written with sheer conviction! Thanks for sharing this. You have power packed this article with lot of important facts rotator cuff repair, plantar fasciitis