Rotator Cuff Repair
Arthroscopic Rotator Cuff Repair
Erick Marigi MD – Rotator Cuff Repair Surgeon in Jacksonville, FL
What is The Rotator Cuff and What are Rotator Cuff Tears?
The rotator cuff is a group of four muscles that play a vital role in shoulder stability and movement. These muscles originate from the shoulder blade (scapula) with their tendons forming a “cuff” around the humeral head. Each muscle has a specific attachment on the humerus: the Subscapularis inserts on the front, the Supraspinatus inserts on the top, and the Infraspinatus and Teres minor both insert on the back of the shoulder. Together the rotator cuff allows you to lift, reach, and rotate your arm to perform everyday activities and sports.
As the shoulder is heavily relied upon for daily activities, the rotator cuff is susceptible to injuries such as strains, tendinopathy, and tears. Rotator cuff tears are a leading cause of shoulder pain and weakness, especially in people who perform repetitive overhead motions. Studies estimate that 20 – 30% of adults have rotator cuff tears with the prevalence increasing to nearly 50% in people over 60 years of age.
Acute Full Thickness Rotator Cuff Tears
A full-thickness rotator cuff tear occurs when a tendon is completely (100%) torn from the footprint. These tears are classified by size: small (< 1 cm), medium (1 – 3 cm), large (3 – 5 cm), and massive (> 5 cm). Acute full-thickness tears often result from a traumatic event typically causing immediate pain and loss of shoulder function. Timely surgical repair is generally recommended as delays can lead to tendon retraction and irreversible changes in the muscle. These changes include fatty infiltration and atrophy, a process where the healthy muscle will become irreversibly replaced with non-functional tissue, subsequently limiting the chances of a complete recovery.
Chronic Rotator Cuff Degeneration and Tearing
Most rotator cuff tears gradually develop as an unfortunate consequence of our natural aging process. The rate of this process varies among individuals and can be influenced by genetics, occupation, and activity level. Chronic rotator cuff tears typically cause slowly worsening symptoms over time, including pain on the side of the shoulder, weakness with overhead activities or lifting, and, most notably, night pain that disrupts sleep.
Non Surgical Treatment of Rotator Cuff Tears
Although rotator cuff tears do not heal on their own, most do not require surgery unless they are acute traumatic full thickness tears. In fact, many patients with rotator cuff tears experience significant symptom relief with non-operative treatments focused on reducing inflammation, and improving shoulder function through dedicated scapular based therapy.
Inflammation reduction is typically managed with activity modification, ice, oral anti-inflammatory medications (ibuprofen, meloxicam, etc.), and selective targeted injections. Physical therapy functions through strengthening the surrounding shoulder muscles to help compensate for the tear. With modern supervised therapy techniques, a 6 – 12 week program has been shown to be successful in over 70% of patients with a symptomatic, atraumatic rotator cuff tear.
Who is a Candidate for an Arthroscopic Rotator Cuff Repair?
Candidates for arthroscopic rotator cuff repair are selected based on individual patient factors and the specific characteristics of the tear. Physical therapy can strengthen surrounding muscles but does not heal the torn tendon, and untreated tears may progress over time. Arthroscopic repair restores the tendon to its original attachment, limiting further damage and maximizing recovery potential. Therefore, surgery is generally considered when non-surgical treatments have failed to relieve pain or restore function, or when the risk of tear progression is high.
- Acute Traumatic Full-Thickness Tears: These often result from a sudden injury such as a fall or heavy lift. Early surgical repair ideally within 6 – 8 weeks is recommended to optimize tendon healing and muscle recovery.
- Chronic Partial- or Full-Thickness Tears unresponsive to Non-Surgical treatment: Patients who continue to have pain or functional limitations after a comprehensive course of physical therapy and other conservative measures may benefit from surgery to bridge their symptom needs.
- Significant Pain and Weakness that interfering with Daily activities: When symptoms persist and impact quality of life despite non-operative management, arthroscopic repair can restore function and reduce the risk of further tendon degeneration.
How is the Rotator Cuff Repaired?
Most tears, regardless of the size, can be repaired. Dr. Marigi performs nearly all of his rotator cuff repairs arthroscopically with 3 – 5 small incisions (< 8 mm). This minimally invasive technique typically results in less pain and a faster recovery compared to a traditional open approach. The procedure begins with an arthroscopic (camera) assessment of the tear and the shoulder joint. Any pain generators such as loose bodies, bone spurs, or the biceps tendon are addressed at the same time. Often the long head of the biceps tendon is damaged, and is subsequently treated with a biceps tenodesis (removing the damaged portion and reattaching it to the humerus).
Additionally, any present and symptomatic bone spurs overlying the rotator cuff are identified and removed. The decompression raises the roof of the subacromial space, smoothens the undersurface of the acromion, and relieves pressure on the underlying rotator cuff tendons.
Treatment of the rotator cuff depends on the severity of the tear. Partial-thickness tears involving < 50% of the tendon are usually debrided and may be augmented to promote healing. Tears > 50% thickness and full-thickness tears are repaired to the bone using suture anchors. The number of anchors (typically 1 to 5) depends on tear size, bone quality, and tendon condition. In cases of poor tissue quality, a graft may be used to support tendon healing and optimize recovery.
What is the Recovery Process After an Arthroscopic Rotator Cuff Repair
- After your surgery, your care team will closely monitor your progress and help manage any discomfort as you begin your recovery. Most patients recover at home or in a nearby hotel if they have traveled for the procedure.
- To optimize rotator cuff recovery, a shoulder immobilizer is worn for the first 6 weeks. Most patients resume basic daily activities, such as dressing and grooming, within 2 weeks. Supervised physical therapy begins early postoperatively, with strengthening at 12 weeks and return to gym activities by 4 months.
- Full recovery, allowing you to return to all activities, depends on the severity of the tear, overall health, and commitment to rehabilitation. This can take approximately 6 months for small tears, however, this can take up to 1 year for large and massive tears.
If you have a rotator cuff tear or want to learn more about arthroscopic rotator cuff repairs, contact Dr. Erick Marigi, an orthopedic shoulder surgeon serving the communities of Jacksonville, Florida and beyond.