Orthopedic Surgery, Shoulder Surgery
September 30, 2019
When to Get Rotator Cuff Surgery
Torn tendons, severe dislocations, tendonitis, and tendinosis can all be cause for rotator cuff surgery. Learn more about rotator cuff injuries and what type of surgery may be required.
About Your Rotator Cuff
Your rotator cuff is a group of muscles, tendons, and cartilage that surround your shoulder joint, giving it stability and allowing it to rotate.
When your shoulders are put under elevated stress, rotator cuff injuries can occur. Accidental falls and sports such as weightlifting, football, tennis, and baseball can lead to rotator cuff injuries.
Here are some of the symptoms of a rotator cuff injury:
- Shoulder pain that makes it difficult or impossible for you to perform daily activities
- Shoulder pain that keeps you from raising your arm above your head
- Shoulder pain that keeps you from falling asleep
- Shoulder pain that wakes you up from sleep
- Popping, clicking, or crackling sensations when you move your shoulder
Even if you’re not sure you have a rotator cuff injury, you should see a doctor if you injure your shoulder. Untreated injuries can lead to more problems later in life, such as frozen shoulder, arthritis, or severe rotator cuff tears.
Types of Rotator Cuff Injuries
Rotator Cuff Tears
Your tendons degenerate over time, leaving them more susceptible to severe injury. If you over-stress your shoulder joint—for example, if you lift a heavy object too quickly—your rotator cuff tendons are at risk of tearing, especially as you age.
A partial rotator cuff tear means your tendon is damaged, but is still in one piece. Doctors typically recommend over-the-counter anti-inflammatory medications for partial rotator cuff tears. Physical therapy is also an option before surgery is considered. However, if non-surgical solutions fail to give you relief, surgery may be necessary.
A full rotator cuff tear means the tendon has torn completely in two. This will require a graft to repair (see Open Surgery section below).
Rotator Cuff Tendonitis
Tendonitis (also spelled “tendinitis”) occurs when your tendons become inflamed or damaged. Rotator cuff tendonitis is commonly seen in those who perform repetitive actions with their arms, such as rowing, golfing, or tennis. Several small injuries can also ultimately result in rotator cuff tendonitis—it is not typically caused by a single major injury.
Symptoms of rotator cuff tendonitis may feel similar to arthritis or a pinched nerve. They include pain when moving, pain at night, and loss of strength in the shoulder. Your doctor may recommend rest, ice, anti-inflammatory medication, steroid injections, and/or physical therapy to treat your rotator cuff tendonitis.
If your pain lasts longer than 6 months, your doctor may recommend surgery. Depending on the severity of your rotator cuff tendonitis, you may require arthroscopic surgery or open shoulder surgery to trim or remove inflamed tissue.
Rotator Cuff Tendinosis
Rotator cuff tendinosis differs from tendinitis in that it is a chronic issue, not one caused by trauma or injury. Treatments for rotator cuff tendinosis include anti-inflammatory medicine, ice, and physical therapy. If those treatments prove unhelpful, your doctor may recommend surgery.
When the ligaments in your rotator cuff and the capsule of your shoulder joint become inflamed and tightened, your shoulder movement becomes restricted. This condition is known as frozen shoulder or adhesive capsulitis.
As you age, frozen shoulder becomes more likely as your tendons degenerate. In addition, if you’ve had a shoulder injury or chronic shoulder pain that hasn’t been treated and your shoulder has been immobile for months, you could be at risk of developing frozen shoulder. Diabetes, rheumatic diseases, and pinched nerves in your neck can also cause frozen shoulder.
Over-the-counter anti-inflammatory medications and physical therapy are common treatments for frozen shoulder. Heat applications, stretching, steroid injections, and electrical stimulation may also be used. However, if your condition is more severe, surgery may be required.
Types of Rotator Cuff Surgery
Rotator cuff surgery should only be considered when nonsurgical treatments prescribed to you by your doctor have failed to heal your shoulder or relieve your pain.
Arthroscopy is a minimally invasive surgical procedure that involves smaller incisions, smaller instruments, and in most cases, a tiny camera. Used to trim or remove inflamed tendons, arthroscopy is ideal for minor rotator cuff tears and minor tendinitis. You can also undergo an arthroscopic procedure to trim or remove bone spurs that could be causing discomfort in your shoulder.
Mini-open repair involves a small incision that is larger than the one made in arthroscopy, but not as large as what is required for open shoulder surgery. You may be a candidate for mini-open repair if you have moderate tissue damage in your rotator cuff that cannot be removed or repaired through arthroscopic surgery.
Open shoulder surgery may be required for severe cases of rotator cuff injury or degeneration. Open surgery for rotator cuff injuries involves grafting tissues from another part of your body to replace damaged tissue.
Reverse Total Shoulder Replacement Surgery
If your rotator cuff has been damaged beyond repair, you may need a reverse total shoulder replacement surgery to regain your overhead range of motion. In a reverse shoulder replacement, your surgeon will replace your damaged shoulder joint with a metal ball and a plastic cup.
When your rotator cuff tendon becomes severely damaged, the ball of the humerus can no longer be held in the shoulder socket properly. For this reason, a traditional shoulder replacement is not recommended for those with severe rotator cuff damage. With a reverse shoulder replacement, your shoulder movement relies on the deltoid muscle instead of the damaged rotator cuff.
Rotator Cuff Solutions
If you suspect you are suffering from a damaged rotator cuff, or if you have questions about other shoulder injuries, Contact Arkansas Surgical Hospital at (877)-918-7020 to make an appointment with one of our specialists.