In a recent article, we dove into the symptoms of rotator cuff tears and how to approach treatment. In this article, we are going to discuss some of the most common treatment options for rotator cuff tears.
The patient may opt to continue with their home program and deal with lingering pain and impairment which is the case for those not interested in surgical intervention due to their age or other medical/family/social concerns. This group may benefit from periodic injection to varied locations about the shoulder complex to stabilize pain symptoms though need to appreciate that the injectable has a degradative effect on soft tissues including the rotator cuff.
Surgical Rotator Cuff Repair
The majority of these procedures are being done via arthroscopy at present which benefits the patient with diminished trauma to regional soft tissues needed to gain access to the shoulder joint. This type of intervention is as successful as the historical “open repair”. Even though the patient will generally experience less overall pain following surgery, it is crucial to appreciate that the healing time for the injured tendon/muscle is the same. One must resist the temptation to do too much too soon. The biceps tendon is located adjacent to the attachment of the rotator cuff muscles and is often a source of pain as well. This tendon is often moved to a location away from the classic point of encroachment to further relieve chronic pain symptoms. The physical therapist under the guidelines of the physicians protocol, guides the patient thru the rehabilitation process. The patient will have moderate impairment and pain for 3-6 weeks with slow stabilization thereafter. The overall process to return to full function takes 9-12 months.
Total Shoulder Arthroplasty (TSA)
An available intervention for over 30 years initially for those with severe osteoarthritis and irreparable pain. With the evolution of the prosthetic components, this procedure became an option for those with moderate to severe rotator cuff injury as well.
Reverse Total Shoulder Arthroplasty (RTSA)
The shoulder joint complex is the most complicated in the body. By reversing the ball and socket position, the most significant modification of the prosthetic component to date, it allows the larger deltoid muscle to take over the process of shoulder elevation. With moderate to severe (massive) rotator cuff tears and no other underlying complications, the general trend in the past few years is to undergo a RTSA. From the patient’s perspective, the recovery (when compared specifically to a massive rotator cuff repair), is quicker (pain generally resolves more quickly) with greater functional outcome than a traditional rotator cuff repair (again for a massive tear) if the rehabilitation protocol is closely followed. Again, for both procedures, physical therapy care under the guidance of physician protocol is initiated. 6 to 12 months of rehabilitation (the majority of this time via independent home exercise) is advised to return to maximal function.
The majority of rotator cuff injuries can be resolved via a conservative model. Surgery is a complicated business and needs to be undertaken only after conservative measures have failed. For those with persisting symptoms, having the correct diagnosis, under the care of the appropriate physician, doing the correct surgical procedure followed by a diligent effort with one’s rehabilitation is the key to success.