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Rotator Cuff Repair

The rotator cuff consists of four muscles that surround the ball and socket joint in the shoulder. Their role is to initiate shoulder movement and to stabilize the joint by compressing the ball against the socket when larger muscles such as the deltoid, trapezius, and latissimus are recruited to perform heavy lifting or overhead activities such as those in tennis or baseball. Overuse and acute traumatic injuries can cause a tear in one or more of the tendons that attach the rotator cuff muscles to the bone on the ball of the shoulder. This is a common injury seen in orthopedic sports medicine clinics. The patient that presents with a rotator cuff tear typically will describe pain or inability to use their arm away from their body. This includes reaching overhead, reaching away from their body and reaching behind the back. Physical examination will often demonstrate weakness in muscle testing of the rotator cuff. X-rays are most often normal. An MRI or an ultrasound test can be used to determine if a rotator cuff tear is present.

Once a tear is identified, the patient and the physician will determine if the patient is a candidate for a trial of conservative treatment including physical therapy, ice and NSAIDs or if they need to consider surgical repair. Rotator cuff tears that are complete will not heal on their own without intervention. However, rotator cuff tears can frequently be handled with conservative management especially if the injury was gradual and due to overuse. Acute injuries, on the other hand, often need to be dealt with by surgery performed within a relatively short period of time after the injury.

Surgical repair performed at Washington University involves a minimally invasive approach. This includes arthroscopy and 3 to 4 puncture wounds to allow instruments to be advanced into the shoulder and reattach the tendon to the ball (humeral head). This is typically performed by placing anchors into the humeral head that have sutures attached to them. These sutures are weaved through the tendon and tied down to reattach it to the bone. The body will then finish the process by healing the tendon to the bone over time. Patients are typically maintained in a sling for 4 to 6 weeks. Physical therapy will consist of range of motion exercises and strengthening once the tendon has been allowed to heal back to the bone. Once strength is regained, patients can return to their usual activities including sports and recreational endeavors.