Rotator Cuff Repair

Rotator Cuff Anatomy & Function

The rotator cuff is a group of four muscles that come together forming a strong tendon (cuff) that inserts on the top of the upper arm bone (humerus). The four muscles that come together to form the rotator cuff are the supraspinatus, infraspinatus, teres minor, and subscapularis. The rotator cuff has a very important function: it holds the humerus in position to allow lifting and rotating of the arm. It is especially important in overhead activities.

Warning Signs

Rotator cuff tears are commonly seen amongst adults. Symptoms include shoulder pain, weakness, and may cause significant disability depending on the extent and nature of the tear. Common signs of a rotator cuff tear include pain and weakness while lifting the arm, difficulty hold the arm up above the head, pain while lowering the arm, and cracking sounds during movement. Frequently patients with a rotator cuff tear complain of difficulty sleeping on the affected shoulder, and pain when attempting certain motions such as reaching for a car seatbelt or trying to comb one’s hair.

Cause

Rotator cuff tears can occur for a variety of reasons. Most commonly cuff tears are seen in people over 40 years old and tend to be caused by repetitive injury and wear and tear. Rotator cuff tears are commonly seen in those who engage in repetitive overhead motions from either work or sport. Although typically a result of overuse of the tendon over many years, rotator cuff tears can also be caused by a single traumatic event such as while lifting an object or during a fall.

Conservative Treatment

When appropriate, Dr. Samimi always prefers to start with conservative treatments for small or partial thickness rotator cuff tears. Conservative treatments include anti-inflammatory pain medication, physical therapy and strengthening exercises, activity modification, and steroid injections.

Surgery

When conservative treatments fail to provide relief or in the case of large or traumatic rotator cuff tears, surgical repair is recommended. Surgical repair of a torn rotator cuff tear will help alleviate pain, allow for increased strength, improve range of motion and prevent further tearing of the cuff.

Depending on the extent, type and nature of the tear, rotator cuff surgery may be different. When a partial tear is present, it may simply require a debridement (smoothening) of the torn portion of the cuff. When a tear is complete (full thickness), the edges of the tendon are brought together and are attached to the bone. Dr. Samimi specializes in the treatment of routine and complex shoulder problems that may be treated with arthroscopic surgery, including rotator cuff repair.

What happens during the Rotator Cuff Repair procedure?

Shoulder arthroscopy is a surgical procedure used to visualize, diagnose, and treat problems inside a joint. The procedure involves making a small incision in the skin and inserting a pencil-sized arthroscope into an injured or damaged joint. The arthroscope’s tiny camera and instrumentation allow Dr. Samimi to see inside the joint in a magnified and illuminated manner to accurately diagnose the extent and pattern of the rotator cuff tear and effectively repair it.

After evaluating the shoulder joint, the orthopedic surgeon places the camera in the space above the rotator cuff tendons, called the subacromial space. The surgeon can check the area above the rotator cuff, clean out inflamed or damaged tissue, and remove a bone spur (acromion spur) that may be causing impingement of the tendon.

The tendon is then either sutured together or attached back to its insertion on the bone using suture anchors. The suture anchors can be made of metal, plastic, or a material that dissolves over time, and do not need to be removed.

At the end of the shoulder surgery, the incisions will be closed with stitches and covered with a dressing (bandage). Typically patients will go home the same day in a sling followed by a course of physical theraphy. The bandage will be removed and showering is allowed 2 days after surgery. The small incisions will simply be covered by a band-aid.

Dr. Samimi will take pictures of the procedure from the video monitor to show you what was found and what was done during the surgery. He feels it is important for you to understand the nature of the problem and exactly what was done to fix it.

Arthroscopy is almost always performed as outpatient surgery and offers such benefits as reduced risk, fewer complications, less postoperative pain, less recovery time, and far less scarring. Using this minimally invasive procedure we perform rotator cuff repair with excellent results.

For detailed information about this condition and treatments such as Rotator Cuff Repair please visit: AAOS Online Service Fact Sheet - Rotator Cuff Tears