The rotator cuff is a common source of pain in the shoulder. It refers to a group of 4 muscles and tendons that hold onto the ball (head of the humerus) and stabilises it. The most commonly affected tendon is the supraspinatus tendon. Having a better understanding of the causes and symptoms of rotator cuff pain can help you take early preventive measures to prevent the injury from getting worse and eventually leading to a rotator cuff tear.
Shoulder surgery to repair a torn rotator cuff most often involves re-attaching the tendon to the head of humerus (upper arm bone). A partial tear, however, may need only a trimming or cleaning-up procedure called a debridement. A complete tear within the thickest part of the tendon is repaired by stitching the two sides back together.
When Rotator Cuff Shoulder Surgery is Recommended
We may recommend surgery for a torn rotator cuff if your pain does not improve with nonsurgical methods. Continued pain and shoulder weakness is the main indication for surgery. If you are very active and use your arms for overhead work or sports, we may also suggest surgery.
Other signs that rotator cuff injury surgery may be a good option for you include:
- Your symptoms have lasted 6 to 12 months
- You have a large tear (more than 3 cm)
- You have significant weakness and loss of function in your shoulder
- Your tear was caused by a recent, acute injury
Rotator Cuff Shoulder Surgery Repair Options
A rotator cuff tear most often occurs where the tendon attaches to the bone.
There are a few options for repairing rotator cuff tears. Advancements in surgical techniques for rotator cuff repair include less invasive procedures. While each of the methods available has its own advantages and disadvantages, all have the same goal: getting the tendon to heal.
Many surgical repairs can be done on an outpatient basis and do not require you to stay overnight in the hospital.
You may have other shoulder problems in addition to a rotator cuff tear, such as osteoarthritis, bone spurs, or other soft tissue tears. During the operation, we will address these problems as well.
We do either an all-arthroscopic repair or a mini-open repair in all our cases.
During arthroscopy (keyhole surgery), we insert a small camera, called an arthroscope, into your shoulder joint. The camera displays pictures on a television screen, and we use these images to guide the manipulation of miniature surgical instruments within the shoulder.
Because the arthroscope and surgical instruments are thin, we can use very small incisions (cuts), rather than the larger incision needed for standard, open surgery.
All-arthroscopic repair is usually an outpatient procedure and is the least invasive method to repair a torn rotator cuff.
During arthroscopy, we insert the arthroscope and small instruments into your shoulder joint.
The mini-open repair uses newer technology and instruments to perform a repair through a small incision. The incision is typically 3 to 5 cm long.
This technique uses arthroscopy to assess and treat damage to other structures within the joint. Bone spurs, for example, are often removed arthroscopically.
Once the arthroscopic portion of the procedure is completed, the surgeon repairs the rotator cuff through the mini-open incision. During the tendon repair, the surgeon views the shoulder structures directly, rather than through the video monitor.
Although blood is mainly a liquid (called plasma), it also contains small solid components (red cells, white cells, and platelets.) The platelets are best known for their importance in clotting blood. However, platelets also contain hundreds of proteins called growth factors which are very important in the healing of injuries.
PRP is plasma with with a much higher concentration of platelets than what is typically found in blood. The concentration of platelets — and, thereby, the concentration of growth factors — can be 5 to 10 times greater (or richer) than usual.
To develop a PRP preparation, blood must first be drawn from a patient. The platelets are separated from other blood cells and their concentration is increased during a process called centrifugation.
PRP may also be used to improve healing after surgery for some injuries. Healing of the repaired rotator cuff tendon can possibly be improved by treating the injured area with PRP during surgery. This is done by preparing the PRP in a special way that allows it to actually be stitched into torn tissues.