Decision to have surgery for rotator cuff injury

By Louis Neipris, M.D., Staff Writer, myOptumHealth

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Some rotator cuff injuries are due to a sudden injury, a fall or car accident, for example. The sheer force of the accident causes a torn rotator cuff tendon. Surgery is a reasonable treatment in some of these cases. But most rotator cuff problems develop gradually as a steady loss of shoulder strength. In this gray zone, surgery may not be the best treatment option. It's important to carefully weigh the pros and cons of surgery versus more conservative treatments to heal any rotator cuff injury.

What is a rotator cuff injury?

The rotator cuff is a group of four muscles behind each shoulder blade. The muscles work together to stabilize the shoulder joint, which lets you raise and rotate your arm. Each of the muscles attaches to the ball of the shoulder joint (humeral head) with a tough band of connective tissue called a tendon.

The two main types of rotator cuff injuries are:

Tendinitis. This leads to inflammation of one of the tendons usually due to overload or overuse. It is common in athletes who perform overhead movements, such as in racquet sports.
A tendon strain or a tear. In a strain, the tendon is pulled to the point of injury, but is still intact. In a tendon tear, it is either partially or completely torn away from the ball of the shoulder joint. A tendon tear can occur suddenly as a due to an injury or gradually from age-related tendonitis that weakens a tendon.

In any type of rotator cuff injury, a decision has to be made between surgery and conservative treatment.

Treatment options

Conservative approach. For about half of the people with rotator cuff problems who try some kind of conservative approach, symptoms resolve without surgery. Conservative approaches may include resting the shoulder, applying heat and ice or physical therapy. The core of conservative therapy is physical therapy that includes exercises to restore shoulder strength and range of motion. Physical therapy may involve teaching you how to move your shoulder differently or to modify your activity to avoid pain.

Pros of the conservative approach

You avoid the complications of surgery.
There's no "down time" due to recovery period.
You can have surgery later if this approach doesn't work

Cons of the conservative approach

It's not as likely to restore strength.
A tear can become larger over time.
Your shoulder may become weaker and you may lose range of motion.

Other treatment options may include corticosteroid injections or acupuncture. But none of the research so far has been able to prove that these treatments are effective in the treatment of rotator cuff disease.

Surgery. Surgical treatment for a rotator cuff injury may be advised if you have a sudden, complete tear as might happen in a sports injury or automobile accident. But surgery may also be a good option if symptoms don't respond to several months of conservative treatment or if you have severe weakness.

The goal of rotator cuff surgery is to reattach the tendon to the ball of the shoulder joint (humeral head). The surgeon may also remove jagged pieces of bone (bone spurs) to reduce friction and prevent damage to the tendon. This is called acromioplasty. The surgeon may do surgery using an arthroscope and several small incisions. This technique makes use of a small lighted viewing instrument (arthroscope) through which the repair is done. Open repair involves a larger incision over the shoulder joint.

Pros of surgery

Provides pain relief
Restores shoulder strength
Improves range of motion

Cons of surgery

Surgery can't fully repair major tears, especially if you've had them for a long time.
The procedure may not restore shoulder strength completely.
There may be nerve damage, as well as other complications of surgery, such as infection or bleeding.

What is important to me?

Other things to consider:

Your doctor will probably suggest at least three to six months of physical therapy to restore your shoulder strength and range of motion. An all-out effort - including exercises to do at home - is needed to get the full benefit.
Be willing to have physical therapy after surgery. If you opt for surgery, you will need to follow through with physical therapy for several weeks after the surgery for a full recovery.
Consider your tolerance of risk. If you decide to have surgery you will need to accept the risks of the procedure.
Be willing to shop around. Find the surgeon with the most experience - and highest success rate - for rotator cuff repair.

View the original Decision to have surgery for rotator cuff injury article on myOptumHealth.com

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American Academy of Orthopaedic Surgeons. Rotator cuff tears and treatment options. Accessed: 10/02/2009

Coghlan JA, Buchbinder R, Green S, Johnston RV, Bell SN. Surgery for rotator cuff disease. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD005619. DOI: 10.1002/14651858.CD005619.pub2.

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