rotator cuff tears and shoulder impingement
What are Rotator Cuff Tears and Shoulder Impingement?
With a complex arrangement of structures all working together to achieve a full range of motion that is necessary for daily activities, the shoulder can be vulnerable to shoulder injuries. These are problems common in young, athletic and the aging population, and it is often experienced as a nagging pain.
Two of the most common problems occur in the narrow space between the bones of the shoulder. Repetitive lifting or overhead activities may result in rotator cuff tears, while irritation within that small space may lead to a pinching condition called impingement syndrome. These two problems may occur separately or together because it is likely that rotator cuff tears result from impingement syndrome and other age-related changes within the rotator cuff tendons.
There are non-operative and operative treatments for these two concerns. Most patients improve with primary or non-surgical treatment alone, which is a physical therapy program. Another option is an anti-inflammatory medication to help reduce the pain and inflammation. If symptoms still do not improve, a steroid injection into the bursa may be given.
Subacromial decompression done arthroscopically or with open incisions, expands the space between the acromion and rotator cuff tendons to correct impingement. A rotator cuff repair, on the other hand, is the surgical treatment for tears. It can also be done through open incisions or through an arthroscopic technique.
Since the rotator cuff is well protected from the front, side, and back by muscles, and it is also inaccessible from the top thanks to the bony acromion, surgeons have their own preferences regarding how they repair torn cuff tissues. This is why an arthroscopic technique would be useful because it provides better visualization and extensive access to the rotator cuff and tear.
You may need a rotator cuff repair if:
- You are active or if you use your shoulders a lot at work or in sports.
- You experience weakness in the affected area impairing your ability to do everyday activities.
- You experience a nagging shoulder pain when you are or at night which hasn’t improved with exercise over 6-12 months.
You may need surgery if:
- You have a complete rotator cuff tear.
- A rotator cuff tear was caused by a recent injury.
- Months of regular physical therapy has not improved your symptoms.
- You are significantly healthy to undergo the procedure.
- You are capable and willing to undergo a comprehensive post-operative physical therapy program.
You will be in a seated position for this surgery. Once you are comfortably positioned, an anaesthetic will be administered and the shoulder is given a sterile wash before it is draped for surgery. The surgeon begins by assessing the shoulder to examine the relative stability of the joint, its range of motion and feel for any abnormal grinding or catching of the joint.
The arthroscopic technique, which is the less invasive option, involves two to three puncture wounds where the thin surgical instruments and arthroscope will be inserted. With images of the internal structures on the monitor, the surgeon is guided as he maneuvers the camera around.
Through the hollow instruments inserted, the surgeon irrigates the shoulder joint with sterile saline solution to “inflate” the joint area. The doctor will then remove the inflamed portion of the bursa (a fluid-filled sac or sac-like cavity that will counter friction at a joint) to create more space for the rotator cuff. He will remove bone and soft tissue to relieve the impingement.
If a tear is found in the rotator cuff at the time of surgery, it can be repaired by reattaching the tendons to the bone. Suture anchors called rivets are used by attaching it to the anchors which tie the tendon back to the bone. These suture anchors can be made out of metal or materials that dissolves over time.
While adverse events following this surgery are rare, they cannot be completely eliminated. The risks involved in a Rotator Cuff Tear and Impingement surgery include:
- Permanent joint stiffness
- Temporary or permanent injury to the nerves and blood vessels around the shoulder
- Recurrent tears of the rotator cuff
- Allergic reactions to suture materials
The success of your surgery depend on the partnership between you and your surgeon. You should disclose any health issues, allergies, and your non-prescription and prescription medications.
It is also important that you optimize your health in preparation for your surgery. Any heart, lung, bladder, kidney, tooth or gum problems should be managed before undergoing surgery. You must also stop smoking and any regular intake of alcoholic beverage at least 2-4 weeks prior to surgery to avoid complications.
You must also plan for necessary assistance well in advance. If you live alone, start making arrangements for home help because it is advised that you be less active and functional for 12-16 weeks after surgery. Repetitive arm activities, overhead chores, lifting, driving and even shopping may be difficult or impossible during this time. In fact, complete rehabilitation and restoration to normal function can take more than 6 months.
Before you even finalize your plan, you must have the willingness to make an effort to rehabilitation after surgery. It is important for patients to realize that this procedure is not an event but a process. It will take time and dedication.
The rehabilitation process for impingement begins almost immediately. With therapy, you may already be asked to do exercises that will help regain shoulder motion. At 6 weeks, most patients would have regained full range of motion and they can continue to build strength with a home exercise routine.
Recovery for a rotator cuff repair is generally slower and it requires more supervision. Therapy is integral to your recovery and it has to be controlled in the first 6-12 weeks while the tendons heal or attach back to the bone. There should be no active use of the shoulder to protect the surgical repair. Once initial healing has taken place, you may start with progressive stretching and strengthening. Some patients may take longer to regain muscle strength and achieve complete healing, while others fully recover after 6 months.
Pain is your body’s way of telling you that something is not right. Don’t just brush it off and risk the chance of compromising your movement and interupting your daily activities. Get it checked today for the right intervention the soonest possible time. Book your appointment with Dr. Dutton, here.
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