Unfortunately tears of the rotator cuff have little ability to heal themselves. If a patient does not respond to nonoperative treatment, your Rothman sports medicine physician may then prescribe surgery.Surgery may also be an option if the tear is acute and extremely painful, if it is the dominant arm of an athlete or worker, or if maximum strength is needed for daily occupational activities. Early surgery is indicated if the tear was caused by a significant injury and is associated with weakness or inability to raise the arm.
The type of surgery performed depends on the shape, size, and location of the tear. In cases of tendonitis, surgery, which is termed “subacromial decompression”, involves removal of the inflamed bursal tissue over the rotator cuff and shaving of the acromion bone which can narrow the space above the rotator cuff. A partial tear may only require a trimming or smoothing procedure called a “debridement.” A complete tear that occurs within the substance of the tendon is repaired by stitching the two sides of the tendon. However, if the tendon is completely torn away from its insertion on the humerus bone, it can be repaired directly to the bone.
Most surgical procedures can be performed on an outpatient basis. There are three general approaches available for surgical repair:
Arthroscopic repair- Through the use of a tiny fiber optic scope and other small instruments inserted through small puncture wounds, your Rothman physician can repair the damaged tendon under video control. This eliminates the need for a large, open incision.
Mini-open repair- Advanced instrumentation and techniques now allow orthopaedic surgeons to perform complete rotator cuff repair procedures through a four to six centimeter incision.
Open surgical repair- If the rotator cuff tear is large or complex or if additional reconstruction (such as a tendon transfer) has to be performed, then a traditional open surgical incision is required. In some extreme cases, where arthritis has developed, shoulder replacement surgery may be required.
