What is a Rotator Cuff?
Your rotator cuff is a collection of four muscles and their tendons that are accountable for keeping the shoulder joint stable and are called the Supraspinatus, Infraspinaturs, Teres Minor, and Subscapularis. The rotator cuff is what assists you to raise and rotate the arm.
What causes a Rotator Cuff Tear?
The rotator cuff tendons have sections of very low blood supply. The more blood supply a tissue has, the better and faster it can repair and sustain itself. The areas of poor blood supply in the rotator cuff make these tendons particularly vulnerable to degeneration from aging. Rotator cuff tears normally occur in sections of the tendon that had low blood supply to begin with and then were further weakened by degeneration.
This problem of degeneration may be expedited by duplicating the same types of shoulder motions. This can happen with overhand athletes, such as baseball pitchers. But even doing everyday chores such as cleaning windows, washing and waxing cars, or painting can cause the rotator cuff to fatigue from overuse.
Extreme force can tear weak rotator cuff tendons as well. This force can originate from trying to catch a heavy falling object or lifting an extremely heavy object with the arm extended. The force can also be from a fall directly on the shoulder.
Rotator cuff tears are called either “full thickness” or partial thickness,” depending on how severe they are.
- Full-thickness tears extend from the top to the bottom of a rotator cuff muscle/tendon.
- Partial-thickness tears affect at least some part of a rotator cuff muscle/tendon, but do not extend all the way through.
What is a Rotator Cuff Repair Surgery?
A complete rotator cuff tear will not heal. Complete ruptures usually require surgery if your goal is to restore your shoulder to normal function. The exception is in elderly patients or patients who have other diseases that increase the risks of surgery. There is some evidence that repairing the rotator cuff within three months of the injury results in a more favorable outcome. You will need to work with your surgeon to decide when is the best time to do the surgery.
Partial tears may not require surgical repair. If you have a partial tear, your surgeon will most likely want to give your rotator cuff a chance to heal on its own. But if you can’t endure the pain, or if you can’t use your arm, you may need to contemplate surgery.
There are different surgeries and the correct one will be decided by your surgeon, but the most popular is an arthroscopic repair. Surgeons usually get outstanding results using an arthroscope to repair a torn rotator cuff. The first step involves careful removal of any unhealthy, degenerated rotator cuff tissue. Then, the area of the humerus bone where the tendon tore away is prepared for reattaching the tendon. To do this, the surgeon extracts the soft tissue to form a raw bony area. Drill holes are made in the humerus for fastening sutures. The tendon is then sewn together and stitched to the humerus by looping sutures through the drill holes. The tendon heals to the bone over time, reattaching itself.
What to expect after Surgery?
The surgical procedure to repair a torn rotator cuff is most often the easiest and most straightforward phase of treatment, and the rehab and recovery is the most challenging!
Day Of Surgery
Rotator cuff surgery is an outpatient procedure. Overnight stays in the hospital are usually unnecessary. The surgical procedure usually takes a few hours, depending on the amount of work needed to repair the torn tendons. After surgery, your arm will be placed in a sling. A sling that holds the arm slightly away from the side (an abduction sling) is generally recommended for rotator cuff repair surgery, as these hold the tendons in a more relaxed position. You will remain at the hospital until your pain is sufficiently controlled.
Phase I: Passive range of motion
Passive motion means the rotator cuff muscles and tendons are not doing any work. When the rotator cuff muscles contract, tension is placed on the repair that was completed. Passive motion means that the shoulder moves without putting tension on the repair. To perform passive motion, your therapist will move your shoulder for you. The therapist can also educate you on how to move your shoulder without contracting the rotator cuff muscles. This may last up to 6 weeks depending on the extent of the repair.
Phase II: Active range of motion
Active motion is received when there is adequate healing of the tendons to allow them to start moving the arm, but before any extra resistance is applied. You may be restricted to active motion for up to 12 weeks from the time of surgery. Active motion means that you can move your arm, but not against resistance.
Phase III: Strengthening and Stabilizing
The strengthening phase of recovery is the most important. Because of the injury, surgery, and early phases of recovery, the muscles of the rotator cuff have become weak. Once the repair has sufficiently healed, it is essential to begin strengthening the muscles to allow you to resume your normal activity level.