Rotator Cuff Tear & Repair

The shoulder is a complex joint involving three main bones: the humerus (upper arm bone), the clavicle (collarbone), and the scapula (shoulder blade). The upper part of the scapula, known as the acromion, creates the shoulder’s top area. The primary joint, the glenohumeral joint, connects the humerus and scapula, enabling the shoulder's wide range of motion.

The glenohumeral joint acts similarly to a ball-and-socket, where the humeral head (rounded top of the upper arm bone) sits in the shallow socket (glenoid) of the scapula. Strong tissues, including the joint capsule and ligaments, hold the joint together and stabilize the upper arm.

The four rotator cuff muscles form a tendon cuff, allowing arm rotation and movement in multiple directions. A fluid-filled sac, the subacromial bursa, reduces friction during motion, enabling smooth shoulder movements, such as reaching overhead or performing daily tasks.

Rotator cuff tears are more common in the dominant arm and tend to increase with age due to reduced blood flow to tendons, leading to tissue degeneration and weakness. Degeneration may cause bone spurs on the acromion, which can irritate the tendons, resulting in a condition called shoulder impingement syndrome. This condition can lead to painful tears or tendonitis, where inflamed tendon tissue becomes sore and tender.

Younger individuals may experience rotator cuff tears following trauma, like a fracture or dislocation, or due to repetitive overhead movements common in sports (e.g., tennis or baseball) and occupations involving repetitive reaching.

Gradual onset of pain is a typical symptom of a rotator cuff tear, starting near the front of the shoulder and possibly radiating down the arm. Pain may be mild initially but can worsen with movement or even at rest, potentially interrupting sleep. Symptoms can include shoulder stiffness, restricted arm mobility, crackling sounds, and weakness, particularly when lifting or rotating the arm. Traumatic injuries typically result in immediate pain, weakness, and restricted arm function.

Doctors diagnose rotator cuff tears through physical examination, imaging, and medical history review. They assess movement and muscle strength to evaluate shoulder stability and may use X-rays to inspect the bones for signs of arthritis or bone spurs. In some cases, a more detailed Magnetic Resonance Imaging (MRI) scan or ultrasound may be necessary to visualize soft tissue injuries, including the size and nature of the tear.

Non-surgical options often include rest, avoiding overhead motions, wearing a sling, and pain management with medications or corticosteroid injections. Physical therapy is also beneficial for restoring shoulder strength and function.

When non-surgical treatments are insufficient, surgery may be recommended, particularly for individuals who rely on shoulder strength for work or sports. Surgical options vary depending on the tear’s severity, ranging from debridement for partial tears to full tendon repair.

Surgical approaches include:

• Open Surgical Repair: Involves a larger incision and may include removing bone spurs (acromioplasty).
• Mini-Open Repair: Uses smaller incisions and an arthroscope for minimal tissue disruption.
• All-Arthroscopic Repair: Uses small incisions and an arthroscope, reducing recovery time and infection risk.

Post-surgery recovery typically involves wearing a sling and gradually increasing movement under the guidance of a physical therapist. Full recovery may take four to six months, depending on the surgery type and individual factors.