Rotator Cuff Tear Treatment Options

For symptomatic, nontraumatic rotator cuff tears a trial of conservative treatment with rest, icing, anti-inflammatory medications called NSAIDS, and physical therapy are typically the first option.  Steroid injections may be recommended to address continued pain, and for pain that interferes with physical therapy, sleep, or daily activities. Many patients with minor tears can find relief from shoulder pain and improved function with conservative treatment. Yet, some people have such serious pain that it interferes with their quality of life after an initial trial of conservative treatment.

Conservative management may not be recommended for a patient with a large full thickness tear due to concern over tear progression over time that could lead to increased disability and difficulty with subsequent repair. Surgery for acute full thickness tears should be accomplished as soon as possible and within four months of the injury to avoid issues with scarring and continued damage to the shoulder tissues.

Surgical rotator cuff repair may be recommended if:

• The patient has an acute large tear or a full thickness tear and good quality tendon tissue.
• Pain lasts 6-12 months and fails to improve with conservative management. Continued pain is a primary indication for surgery.
• There is significant shoulder weakness and loss of shoulder function.
• The tear is due to a recent traumatic injury.
• For patients with rotator cuff injury who are active in overhead sports or work, or repetitive activity, surgery may be the best option. In many cases, the patient will have an option for minimally invasive arthroscopic repair, mini-open or open repair.

The goal of surgery is to repair the torn tendon and for it to heal. For a partial tear the damaged tendon tissue is trimmed in a procedure called debridement.  For full thickness tears the surgery reattaches the tendon to the head of the upper arm bone with special anchors.

Recent advances in arthroscopic surgical techniques have improved the surgical repair of rotator cuff tears. Surgery may include removing part of the bone to widen the tendon passage in addition to surgical repair of the torn tendon(s). Most rotator cuff surgery is performed arthroscopically or though small incisions (mini-open technique).

Minimally invasive arthroscopic tendon repair

This is the preferred procedure for RCT repair. Arthroscopic repair can reattach tendon to bone, restore anatomy, and remove bone spurs. Arthroscopic repair for partial tears is called debridement. Debridement involves the removal of loose pieces of a tendon and other debris in the joint to restore smooth movement.

Arthroscopic tendon repair is an outpatient procedure performed under general anesthetic and a nerve block. It is the least invasive surgical procedure. During arthroscopic repair an arthroscope, a small camera on a thin tube, is inserted into the shoulder joint through small incisions so that Dr. Petrigliano can see inside the joint. The camera projects pictures of the inside of the joint onto a television screen. Then, Dr. Petrigliano evaluates the tissues and guides tiny instruments to perform the repair.  The type and extent of the repair depends on each patient’s circumstances.

The benefits of arthroscopic repair include less damage to surrounding tissues, less bleeding, less postoperative swelling, a reduced risk of pain and complications and faster recovery and return to full function.  Recovery from arthroscopic RCT can take up to 6 months.

Mini – open repair

A mini-open surgery includes arthroscopy and open surgery. It involves removal or repair of all damaged tissue and bone spurs arthroscopically. It uses arthroscopy to assess and treat damage to the joint including bone spurs. After the other damage is fixed, repair to the rotator cuff is accomplished through a small incision 2–3-inch incision without the arthroscope. The tendon is reattached to bone with sutures.

After shoulder surgery you will wear a sling for support and to protect the shoulder joint. Recovery can take 4-6 months. Physical therapy is essential to restore motion and strength.

The risks of rotator cuff repair include the risks commonly associated with all surgery including bleeding and infection. Specific risk of rotator cuff repair includes re-tear of the rotator cuff and post-operative stiffness.  When Dr. Petrigliano recommends surgery he and his team will advise you about what to expect, answer your questions, and provide you with complete pre op and post op instructions.