Rotator Cuff Tears - PDF Document

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  1. CHA Department of Orthopaedics Rotator Cuff Tears Jason A. Freedman, MD Orthopaedic Surgery| Sports Medicine | Arthroscopy | Shoulder Reconstruction The rotator cuff is composed of the tendons from the four muscles that attach the scapula (shoulder blade) to the head of the humerus. These muscles, the supraspinatus, infraspinatus, teres minor and subscapularis, allow rotation movement and stability of the shoulder joint. Pain occurs with overhead and reaching activities as well as when lowering the arm from a raised position. There may also be weakness in lifting the arm and a catching or crackling sensation in the shoulder. Rotator cuff tears will not heal on their own; they may remain stable in size or can progress and become larger. However, symptoms may be controlled with conservative management and allow a return to normal function. Nonsurgical treatment focuses on reducing pain and inflammation initially and then progresses to improving motion and strength in the shoulder. Anti-inflammatory medication, such as ibuprofen or naproxen, will help with pain and inflammation. A cortisone steroid injection in the space surrounding the rotator cuff tendon applies anti-inflammatory medication directly around the tendon to help decrease pain. Physical therapy helps to decrease pain with direct hands-on modalities, such as ice, heat, ultrasound and electrical stimulation. Exercises are then added to restore motion and strengthening and control the rotator cuff and shoulder blade muscles. A rotator cuff tear can arise from a specific traumatic injury. More commonly, a tear may result from wear and tear over time from repeated overhead activities during work or sports activity. The tendons may be predisposed to tearing as patients age due to decreased blood supply and extrinsic compression from bone spurs from the overlying acromion bone. Symptoms of a rotator cuff tear include pain in the front and side of the shoulder that can radiate down the side of the arm. Rotator Cuff Tear Normal rotator cuff (arthroscopic intra-articular view) HH-Humeral head RC-Rotator Cuff Rotator cuff tear (arthroscopic intra-articular view) HH-Humeral head RC-Rotator Cuff Diagram of rotator cuff tear MRI of normal rotator cuff (arrow) MRI of torn rotator cuff (arrow) GR18_332

  2. Surgical management is indicated when nonoperative treatment has failed. In addition, evidence has shown that repairing an acute tear after a traumatic injury will result in a better outcome. Rotator cuff tears used to be repaired through an open incision in the shoulder three to four inches in length. The inflamed tissue and bone spurs surrounding the rotator cuff are debrided to allow visualization of the torn tendon. Bioabsorbable anchors are placed into the portion of the humeral head from where the tendon has torn off. Sutures from the anchor are passed through the free edge of the tendon tear and then are tied down to secure the tendon to the bone. Rehabilitation after surgery involves wearing a sling with an abduction pillow to support the arm and protect the repair for 4 weeks. Physical therapy starts shortly after the surgery, focusing on decreasing pain and swelling and regaining motion with passive stretching. Active motion, where you use your own muscles to move your arm, starts after 6 weeks; after 12 weeks, formal strengthening exercises begin. Complete recovery can take 6 to 9 months. posterior view lateral view Rotator cuff tear (arthroscopic subacromial view) HH-Humeral head FE-front edge of tear BE-back edge of tear IE-inner edge of tear However, technology and techniques have evolved allowing complete arthroscopic repair through a few small incisions (1 centimeter in length each) using a small camera and special instruments. Arthroscopic rotator cuff repair with suture anchor being placed into bone HH-Humeral head RC-rotator cuff A-anchor S-sutures lateral view Arthroscopically repaired rotator cuff posterior view Jason A. Freedman, MD Orthopaedic Surgery (617) 665-1566 CHA Cambridge Hospital Bone & Joint Center 1493 Cambridge St. Cambridge, MA 02139 CHA Assembly Square Bone & Joint Center 5 Middlesex Ave. Somerville, MA 02145