What you need to know about rotator cuff repairs

A rotator cuff injury involves damage or tearing of the muscles and tendons comprising the rotator cuff in the shoulder. These injuries can range from mild inflammation to severe tears, often resulting from overuse, repetitive motions, traumatic injuries, or degenerative changes associated with aging.

Diagnosis of a rotator cuff injury involves a thorough physical examination by an orthopedic specialist or physical therapist, along with imaging tests such as X-rays, ultrasound, or MRI scans to assess the extent of damage.

Treatment options vary depending on the severity of the injury and may include rest, physical therapy, anti-inflammatory medications, corticosteroid injections, or in more severe cases, surgical repair.

Symptoms of a rotator cuff injury

• Pain

• Weakness

• Limited range of motion

• Difficulty sleeping

• Crackling sensation

• Muscle atrophy

Common causes of rotator cuff damage

• Overuse or repetitive motion: Engaging in repetitive activities or motions that strain the shoulder joint, such as overhead lifting, throwing, or repetitive arm movements, can lead to gradual wear and tear on the rotator cuff tendons.

• Traumatic injury: Acute injuries, such as falls, direct blows to the shoulder, or sudden impact accidents, can cause tears or damage to the rotator cuff tendons.

• Age-related changes: Degenerative changes in the tendons and muscles of the shoulder commonly occur with aging, making them more susceptible to injury. This degeneration can weaken the rotator cuff and increase the risk of tears or damage.

• Poor posture: Prolonged periods of poor posture, such as slouching or hunching forward, can contribute to muscle imbalances and strain on the rotator cuff, leading to increased risk of injury over time.

• Sports activities: Participating in sports or activities that involve repetitive overhead movements, such as tennis, swimming, or baseball, can increase the risk of rotator cuff injuries, especially if proper technique and conditioning are not maintained.

• Heavy lifting: Lifting heavy objects, particularly with poor lifting technique or inadequate shoulder strength, can strain the rotator cuff muscles and tendons, leading to injury.

How do you repair a rotator cuff?

Treatment options for rotator cuff repair vary depending on the severity of the injury and individual circumstances. Some common treatment approaches include:

• Conservative management: For mild or moderate rotator cuff injuries, conservative treatments may be recommended initially. This may include rest, activity modification, and avoiding activities that exacerbate symptoms. Physical therapy exercises to strengthen the muscles around the shoulder joint and improve range of motion may also be prescribed.

• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen may be recommended to help reduce pain and inflammation associated with rotator cuff injuries. In some cases, corticosteroid injections directly into the shoulder joint may be used to provide temporary relief of pain and inflammation.

• Physical therapy: A structured physical therapy program supervised by a qualified therapist can help improve shoulder strength, flexibility, and function. Specific exercises targeting the rotator cuff muscles and surrounding shoulder muscles can help promote healing and restore mobility.

• Biological treatments: Platelet-rich plasma (PRP) injections or stem cell therapy may be considered as alternative treatment options for rotator cuff injuries. These treatments involve injecting concentrated growth factors or cells into the injured area to promote tissue healing and repair.

• Surgical repair: In cases of severe rotator cuff tears or failure to respond to conservative treatments, surgical repair may be necessary. Arthroscopic surgery or open surgery techniques may be used to repair the torn tendon and restore shoulder function. Surgery may involve trimming damaged tissue, reattaching torn tendons to the bone, or performing tendon transfers in some cases.

The choice of treatment depends on factors such as the severity of the injury, the patient's age, activity level, overall health, and treatment goals. A healthcare provider will work with the patient to develop a personalized treatment plan tailored to their specific needs and preferences.

Rehabilitation process after rotator cuff repair

The rehabilitation process after rotator cuff repair is crucial for restoring strength, mobility, and function to the shoulder. While the specifics of the rehabilitation program may vary depending on factors such as the extent of the injury and the surgical technique used, the general phases of rehabilitation typically include:

• Immobilization phase: Immediately following surgery, the shoulder may be immobilized in a sling to protect the repaired tendon and allow it to heal properly. During this phase, passive range of motion exercises may be initiated to prevent stiffness and maintain mobility in the shoulder joint.

• Early motion phase: As healing progresses, typically within the first few weeks after surgery, gentle active and passive range of motion exercises are introduced to gradually increase mobility in the shoulder. Physical therapy sessions may focus on gentle stretching and strengthening exercises to improve flexibility and prevent muscle atrophy.

• Strengthening phase: Once adequate healing has occurred, usually around 6-12 weeks after surgery, more intensive strengthening exercises are introduced to rebuild muscle strength and endurance in the shoulder. These exercises may target the rotator cuff muscles as well as the muscles surrounding the shoulder joint. Resistance bands, weights, or therapeutic exercises using pulleys may be incorporated into the rehabilitation program.

• Functional training phase: In the later stages of rehabilitation, typically around 3-6 months post-surgery, functional training exercises are introduced to simulate activities of daily living and sports-specific movements. The focus is on improving overall shoulder stability, coordination, and proprioception to enable the individual to return to their desired level of activity or sport safely.

• Return to activity phase: Once the shoulder has regained sufficient strength, mobility, and stability, a gradual return to normal activities, work, and sports participation can be initiated. It's essential to follow the guidance of the healthcare provider or physical therapist regarding the timing and progression of activity to avoid re-injury and ensure optimal recovery.

Throughout the rehabilitation process, close communication between the patient, physical therapist, and healthcare provider is essential to monitor progress, address any concerns, and adjust the rehabilitation program as needed. Adherence to the prescribed exercises and guidelines is key to achieving successful outcomes and minimizing the risk of complications.