It happens. Rotator cuffs wear out. Because most rotator cuff tears are caused by normal wear and tear that comes with aging, people over 40 are at a higher risk. That risk increases for those involved in arm and shoulder dominant sports, like tennis, or in occupations requiring repetitive, overhead lifting, like painting. The good news is that with today’s less invasive arthroscopic surgery, incisions are smaller, recovery is shorter and surgery can be done as an outpatient.
For Perimeter Orthopaedics’ patient, C. Day of Cumming, GA, playing handball, racquetball and pickleball were his passion. So at 77 years old, when he began feeling pain in his right shoulder, he had an idea of what it might be. Having had his left rotator cuff repaired seven years prior, he was familiar with the dull shoulder ache. Remembering his long recovery, he was determined to do everything possible to avoid surgery again.
Understanding Shoulder Anatomy:
The shoulder is a ball-and-socket joint: the ball, top of your upper arm bone (humerus), fits into a shallow socket in your shoulder blade (scapula). Your arm is kept in your shoulder socket by your rotator cuff. The rotator cuff is a group of four muscles that come together as tendons to form a covering around the head of the humerus. The rotator cuff attaches the humerus bone to the shoulder blade and helps to lift and rotate the arm. When one or more of the rotator cuff tendons is torn, the tendon no longer fully attaches to the head of the humerus.
Daniel Nicholson, MD explains why rotator cuff tears are common. https://youtu.be/jxAg8RsdVls
Common Symptoms of a Rotator Cuff Tear:
- Pain at rest and at night.
- Pain when lifting and lowering your arm.
- Weakness when lifting or rotating your arm
The goal of any rotator cuff treatment is to reduce pain, restore function and get the tissue to heal. There are several treatment options for a rotator cuff tear, and what works for one person may not work for others.
More conservative, non-surgical treatments include:
- Rest the arm. Support the shoulder with a sling.
- Nonsteroidal anti-inflammatory medication, such as Naproxen, to reduce pain and swelling.
- Strengthening and flexibility exercises and physical therapy.
- Steroid injections: An injection of a local anesthetic and a cortisone preparation may be helpful.
- Many people have benefited from regenerative medicine therapies, including stem cell treatments, as it can help reduce pain and repair the damage to the tissue.
Mr. Day Researches His Options:
When Mr. Day began researching his treatment options, he discovered several non-surgical choices and learned about stem cell therapy. Through his online research, he found Orthopaedic Sports Medicine Specialist, Dr. Daniel Nicholson. Mr. Day commented, “When I met Dr. Nicholson, I immediately liked him and was impressed with his knowledge and the options he presented. He suggested I try PRP (platelet rich plasma) http://bit.ly/2OnQO8u and shockwave therapy http://bit.ly/2RRwizs. Unfortunately, neither one helped me.” For Mr. Day, the obvious next step was surgery. Dr. Nicholson told him about the benefits of less invasive arthroscopic rotator cuff surgery with shortened recovery time and less pain.
Surgical Treatment Choices:
A doctor may recommend surgery if the pain does not improve with nonsurgical methods. Surgery to repair a torn rotator cuff involves re-attaching the tendon to the head of humerus (upper arm bone). There are a few options for repairing rotator cuff tears.
A traditional open surgical incision (several centimeters long) is often required if the tear is large or complex. Open repair was the first technique used for torn rotator cuffs. Over the years, new technology and improved surgeon experience has led to less invasive procedures.
During arthroscopy, your surgeon inserts a tiny camera, called an arthroscope, into your shoulder joint. The camera displays pictures on a monitor, and your surgeon uses these images to guide miniature surgical instruments. Because the arthroscope and surgical instruments are thin, your surgeon can use very small incisions, rather than the larger incision needed for standard, open surgery. All-arthroscopic repair is usually an outpatient procedure and is the least invasive method to repair a torn rotator cuff.
The mini-open repair uses newer technology and instruments to repair a tear through a small incision. The incision is typically 3 to 5 cm long. This technique uses arthroscopy to assess and treat damage to other structures within the joint. Once the arthroscopic portion of the procedure is completed, the surgeon repairs the rotator cuff through the small open incision.
Mr. Day’s Arthroscopic Procedure:
On November 7th Mr. Day had all-arthroscopic surgery to repair his right rotator cuff. “My surgery took 3.5 hours. The tear was extensive. I had calcium deposits and a bone spur that needed repair. I anticipated it would take time to recover and the pain is still there, but it’s improving every day. On a positive note, my range of motion has greatly improved over the months and continues to get better with physical therapy.”
What to Expect After Surgery:
After surgery, your doctor may use a combination of medications for pain relief and to minimize the need for opioids. A physical therapy program will help you regain shoulder strength and motion. The majority of patients report improved shoulder strength and less pain after surgery from a torn rotator cuff.
Mr. Day concluded, “My recovery is going smoother than before. Last time I was in a sling for seven weeks and this time only four. I am very grateful for the care and honesty I found with Dr. Nicholson. I had a challenging repair, but his skill proved to be great, and I’m on the road to recovery.