My head is spinning with all the information I've found on-line about rotator cuff tears. I'm looking up stuff for my brother whose son (my nephew) is having rotator cuff surgery. It looks like there are all kinds of ways of repairing the tear and different ways to define success afterwards. Could you just give me a little summary on who, what, how, and when? Who should have this operation, how should it be done, when's the best time, and so on?
The rotator cuff is a group of four muscles and tendons that surround the shoulder joint. Together, these muscles, tendons, and their connective tissue covering keep the shoulder both stable (in the socket) and mobile (moving in all directions). A tear in any one or more of the tendons can cause pain, loss of motion, decreased strength, and reduced function.
Rotator cuff tears come in all sizes from small to large. Sometimes the larger, more severe tears are referred to as massive tears. For some patients, the tears can't be repaired. But for those who are good candidates for surgery, surgeons have quite a wide range of choices when it comes to surgical approach and technique. Studies are ongoing to find out which approach and technique has the best results.
And results/success can be measured in many different ways. The surgeon may be thinking of success in terms of retear rates. Success means the repair or reconstruction holds, the tear doesn't retear, and no further operations are necessary. The patient on the other hand is thinking more in terms of being pain free and able to regain strength and perform all former activities.
Surgery for the shoulder has changed over the years. A wide incision and open surgery has given way now to minimally invasive procedures using arthroscopic techniques. Arthroscopic approaches can be all-arthroscopic or arthroscopic combined with a small incision called mini-open. Surgeons choose the approach and the repair method based on the type of tear, size of tear, location of tear, and their own experience and expertise with repair techniques.
Thomas R. Duquin, MD, et al. Which Method of Rotator Cuff Repair Leads to the Highest Rate of Structural Healing. A Systematic Review. In The American Journal of Sports Medicine. April 2010. Vol. 38. No. 4. Pp. 835-841.
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