Repair of the Rotator Cuff
- Posted on: May 16 2018
The shoulder, or glenohumeral joint, is a ball-in-socket joint where the glenoid of the scapula joins with the head of the humerus. The motion is controlled mainly by the rotator cuff. The rotator cuff is made up of 4 separated muscles that each provides a slightly different function. The muscles are as follows:
- Supraspinatus- abduction
- Infraspinatus- external rotation
- Subscapularis- adduction and internal rotation
- Teres minor- adduction and external rotation
Common signs of a rotator cuff tear are pain, weakness, decreased motion, and swelling. A full medication history along with a physical exam can help to create differential diagnoses but imagining is required to be sure. An MRI is the gold standard for diagnosis of a tear and determining if surgery is required. Most tears can be treated conservatively with physical therapy, ice, pain medication, and anti-inflammatories. When pain and weakness does not subside after a course of physical therapy and use of medication, surgery is the next step. Two different type of repairs can be performed. Small tears are fixed with an arthroscopic repair. This involves the use of a camera and multiple small incision. Most commonly 3 ports are made. The torn tendon is pulled and sutured to the bone to allow for the muscle to return to its original pull on the joint. Larger tears are fixed with an open tendon repair. This requires a much larger incision so that the tendon can be relocated to the proper position and reattached to the bone.
The first stage after surgery is immobilization. The person is limited passive range of motion and will use a sling for 4 weeks. At 4 weeks, active assistive range of motion begins and available motion is slowly progressed to end up with full passive range of motion by 8 weeks. After full range of motion is achieved, active range of motion is allowed as tolerated but no strengthening can be performed. Strengthening is held off until 12 weeks post operative. Throughout this whole process, the post operative protocol is a guideline that is to be modified based on the shoulder presentation. A skilled physical therapist is needed to ensure each stage is met and the shoulder is safely progressed. Sadly pain is not instantaneous after surgery. Skilled therapy can help manage the symptoms and can speed up the process. Acupuncture is an alternative to pain medication to help control the symptoms. Make sure to find skilled practitioners to ensure that the most possible function is regained after surgery.