Rotator Cuff Tears: Shoulder Surgery
The shoulder is a large ball-and-socket joint that allows lots of motion. The technological advancement of arthroscopy has allowed us to diagnose many injuries that we could not diagnose before. The increased number of participants in sports and physical activity at the younger and older age makes the incidence of injuries, such as rotator cuff tears, far higher.
Some of the most common shoulder injuries I treat are rotator cuff tears, what we call shoulder impingement syndrome and instability after a dislocated shoulder. Now, rotator cuff tears and shoulder impingement syndrome are kind of a continuum of the same process – shoulder pain caused by a bone spur rubbing on the rotator cuff and causing a tear (torn rotator cuff).
In a typical patient with a torn rotator cuff, if it’s a young person who’s physically active and has a complete tear, we can tell them with great confidence that it’s going to get worse and give lots of trouble if we don’t fix it. You usually don’t do as much conservative treatment for young people with rotator cuff tears. On the other hand, if someone is 65 and has a small, complete rotator cuff tear, it is very reasonable to try medications for shoulder pain treatment, or intra-articular steroid injections, or physician-directed physical therapy. In the end, you let the patient decide. If they are not at a satisfactory pain level or function, then it’s time to discuss shoulder surgery.
Recovery after shoulder surgery generally depends on one very basic principle. At the time of the operation, was something reattached to the bone or two tendons sewn back together, or was it shoulder surgery where something causing pain simply removed? If you just remove something that’s causing pain, like a bone spur, and it’s done arthroscopically without disturbing the tissues of the joint, the recovery is very rapid – one to three weeks. However, reattaching a rotator cuff to the bone still takes six to eight weeks for the tendon to heal to the bone.
Rotator cuff repair in a young person should have 90 percent success rate in experienced hands. Now, in a patient in their 60’s or 70’s, the success rate of a complete healing of the shoulder is less. However, the success rate of patients getting much better and experiencing shoulder pain relief and greater function is very high.