Shoulder Rotator Cuff Tears
Written and edited by Aruna Seneviratne, M.D.
Shoulder rotator cuff tears are painful condition that leads to dysfunction of the shoulder.
Biology: Why does it occur?
Tears can occur due to trauma such as falls, or over time due to degeneration of the tendon or an external bone spur. Rotator cuff tears usually occur in patients in their 60s and above. Younger patients can tear their rotator cuffs, but it’s usually traumatic in nature. Natural history of a rotator cuff tear is for it to get larger. Rotator cuff tears do not heal over time. If neglected, the muscle can atrophy, followed by fatty infiltration of the muscle. This is an irreversible condition, and does not bode well for restoration of normal function, and can lead to development of arthritis. Arthritis in the setting of a rotator cuff tear is called rotator cuff tear arthropathy. Treatment options for this condition is limited and includes such procedures as reverse shoulder replacement. Non surgical treatment comprise of a particular form of exercise called the Reading protocol.
Common Diagnostic Techniques
Small tears of the rotator cuff can be treated non-operatively if the patient becomes symptom free with physical therapy. A home exercise program can also be done.
Dr. Seneviratne treats the vast majority of rotator cuff tears with arthroscopic repair. A small camera is inserted into the shoulder via keyhole incisions, and arthroscopic instruments are used to repair the rotator cuff tendon back down to the bone where it belongs using suture anchors.
There are two types of repair that can be performed – the double row repair and the single row repair. Both types yield good to excellent results, and Dr. Seneviratne with customize your treatment based on a variety of factors. Most tears are treated using the double row technique to provide improved biomechanical fixation strength to the healing rotator cuff tear. Dr. Seneviratne has studied this problem extensively and was involved in basic science research about double row vs. single row repairs
The postoperative course
- Can I drive? Usually in 6 weeks, but as early as 3 weeks if it’s the non dominant arm.
- Can I return to work? About 1-2 days depending on your occupation, but a week off is recommended.
- Can I shower? Yes – in 48 hours.
- Can I resume sexual activity? Yes – within a day or two.
- Can I fly in an airplane? In about 1 week – you must arrange for an aisle seat, have your bags handled by someone else, and you MUST do ankle pumps every 15minutes, as DVT is a major concern. You must also take Aspirin to prevent DVT.