Rotator Cuff Tear: Treatment Options

Dr. Logan shoulder surgeon shoulder doctor

Surgery to repair a torn rotator cuff most often involves re-attaching the tendon to the head of humerus (upper arm bone). A partial tear, however, may need only a trimming or smoothing procedure called a debridement. A complete tear is repaired by stitching the tendon back to its original site on the humerus.

When Rotator Cuff Surgery is Recommended

Your doctor may offer surgery as an option for a torn rotator cuff if your pain does not improve with nonsurgical methods. Continued pain is the main indication for surgery. If you are very active and use your arms for overhead work or sports, your doctor may also suggest surgery.

Other signs that surgery may be a good option for you include:

  • Your symptoms have lasted 6 to 12 months
  • You have a large tear (more than 3 cm) and the quality of the surrounding tendon tissue is good
  • You have significant weakness and loss of function in your shoulder
  • Your tear was caused by a recent, acute injury

Surgical Repair Options

There are a few options for repairing rotator cuff tears. Advancements in surgical techniques for rotator cuff repair include less invasive procedures. While each of the methods available has its own advantages and disadvantages, all have the same goal: getting the tendon to heal.

The type of repair performed depends on several factors, including your surgeon's experience and familiarity with a particular procedure, the size of your tear, your anatomy, and the quality of the tendon tissue and bone.

Many surgical repairs can be done on an outpatient basis and do not require you to stay overnight in the hospital. Your orthopaedic surgeon will discuss with you the best procedure to meet your individual health needs.

You may have other shoulder problems in addition to a rotator cuff tear, such as biceps tendon tears, osteoarthritis, bone spurs, or other soft tissue tears. During the operation, your surgeon may be able to take care of these problems, as well.

The three techniques most commonly used for rotator cuff repair include traditional open repair, arthroscopic repair, and mini-open repair. In the end, patients rate all three repair methods the same for pain relief, strength improvement, and overall satisfaction.

Open Repair

A traditional open surgical incision (several centimeters long) is often required if the tear is large or complex. The surgeon makes the incision over the shoulder and detaches one of the shoulder muscles (deltoid) to better see and gain access to the torn tendon.

During an open repair, the surgeon typically removes bone spurs from the underside of the acromion (this procedure is called an acromioplasty). An open repair may be a good option if the tear is large or complex or if additional reconstruction, such as a tendon transfer, is indicated.

Open repair was the first technique used for torn rotator cuffs. Over the years, new technology and improved surgeon experience has led to less invasive procedures.

All-Arthroscopic Repair

During arthroscopy, your surgeon inserts a small camera, called an arthroscope, into your shoulder joint. The camera displays pictures on a television screen, and your surgeon uses these images to guide miniature surgical instruments.

 
Arthroscopic surgery

During athroscopy, your surgeon can see the structures of your shoulder in great detail on a video monitor.

Because the arthroscope and surgical instruments are thin, your surgeon can use very small incisions (cuts), rather than the larger incision needed for standard, open surgery.

 
Arthroscope and surgical instruments inserted through portals in shoulder

Illustration and photo show an arthroscope and surgical instruments inserted through portals in a shoulder joint.

All-arthroscopic repair is usually an outpatient procedure and is the least invasive method to repair a torn rotator cuff.

 
Arthroscopic photos of healthy shoulder joint and rotator cuff tear

(Left) Arthroscopic view of a healthy shoulder joint.
(Right) In this image of a rotator cuff tear, a large gap can be seen between the edge of the rotator cuff tendon and the humeral head.

 
Arthroscopic photos of rotator cuff tear and repair

(Left) The same rotator cuff tear, as seen from above the tendon.
(Right) The rotator cuff tendon has been re-attached to the greater tuberosity of the humeral head with sutures.

Mini-Open Repair

The mini-open repair uses newer technology and instruments to perform a repair through a small incision. The incision is typically 3 to 5 cm long.

This technique uses arthroscopy to assess and treat damage to other structures within the joint. Bone spurs, for example, are often removed arthroscopically. This avoids the need to detach the deltoid muscle.

Once the arthroscopic portion of the procedure is completed, the surgeon repairs the rotator cuff through the mini-open incision. During the tendon repair, the surgeon views the shoulder structures directly, rather than through the video monitor.

 

Courtesy of: https://orthoinfo.aaos.org/en/treatment/rotator-cuff-tears-surgical-treatment-options/

Author
Dr. Catherine Logan Headshot Dr. Catherine Logan, MD, MBA Catherine Logan, MD, MBA, MSPT, is a sports medicine orthopaedic surgeon specializing in complex knee and shoulder surgery at Colorado Sports Medicine and Orthopaedics (COSMO) in Denver, Colorado. As a former physical therapist & trainer, Dr. Logan provides a distinct expertise in sports injury, prevention, and surgical management.

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