Our Summary

This research paper talks about how to deal with unsuccessful treatments for rotator cuff injuries, which are common, complex, and cause a variety of symptoms. The authors suggest different approaches based on the patient’s age, level of activity, and other factors. For younger, active patients, they suggest trying to fix the repair again, possibly using a patch to help. If that’s not possible but there’s still some muscle left, they recommend a partial repair. If only one part of the rotator cuff is irreparable, a type of surgery called superior capsule reconstruction may help. If there’s significant muscle wasting and multiple irreparable tears, moving a healthy tendon to replace the damaged one could be an option. For older patients who aren’t very active or have severe shoulder arthritis, a type of shoulder replacement surgery may be considered if less invasive treatments don’t work. The authors note that there’s a wide range of reported results for these treatments, and that more long-term research with larger groups of patients is needed to improve how we deal with unsuccessful rotator cuff repairs.

FAQs

  1. What are the treatment options for failed rotator cuff repairs?
  2. What is the suggested treatment for active young patients with failed rotator cuff repairs?
  3. What are the possible reasons for considering reverse total shoulder arthroplasty?

Doctor’s Tip

A helpful tip a doctor might give a patient about rotator cuff repair is to follow the post-operative rehabilitation plan closely. This may include physical therapy exercises to strengthen and improve range of motion in the shoulder, as well as avoiding activities that could put strain on the repaired rotator cuff. Consistent follow-up appointments with the surgeon and physical therapist are important to monitor progress and address any concerns or setbacks. Patience and commitment to the rehabilitation process are key to achieving optimal outcomes after rotator cuff repair surgery.

Suitable For

Patients who are typically recommended for rotator cuff repair are those who have a torn rotator cuff that is causing significant pain, weakness, and limited range of motion in the shoulder. These patients may have difficulty performing daily activities or participating in sports or other physical activities. Additionally, patients who have failed previous rotator cuff repairs may also be recommended for surgery to address the ongoing symptoms and functional limitations.

Timeline

Before rotator cuff repair:

  1. Patient experiences shoulder pain, weakness, and limited range of motion.
  2. Patient undergoes physical examination, imaging studies (such as MRI), and possibly conservative treatment (such as physical therapy or corticosteroid injections).
  3. If conservative treatment is unsuccessful, patient may be recommended for rotator cuff repair surgery.

After rotator cuff repair:

  1. Patient undergoes rotator cuff repair surgery, which may involve arthroscopic or open techniques.
  2. Patient undergoes post-operative rehabilitation, including physical therapy to regain strength and range of motion in the shoulder.
  3. Patient experiences initial pain and discomfort post-surgery, which gradually improves over time.
  4. Patient gradually resumes normal activities and sports, with full recovery typically taking several months.
  5. Patient may experience improved shoulder function and decreased pain after successful rotator cuff repair.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with rotator cuff repair surgery?
  2. How long is the recovery process and what can I expect in terms of pain and rehabilitation?
  3. Will I need physical therapy after the surgery and for how long?
  4. What are my chances of a successful outcome with the recommended treatment plan?
  5. Are there any alternative treatments or procedures that I should consider?
  6. How soon can I return to my normal activities, including work and sports?
  7. What kind of long-term care or maintenance will be needed for my repaired rotator cuff?
  8. Are there any specific exercises or lifestyle changes I should make to help prevent future rotator cuff injuries?
  9. Will I need any additional imaging or tests to monitor the healing process after surgery?
  10. What is the expected prognosis for my specific case, considering factors such as age, activity level, and the extent of the rotator cuff injury?

Reference

Authors: Chan E, Remedios S, Wong I. Journal: Sports Med Arthrosc Rev. 2023 Dec 1;31(4):120-128. doi: 10.1097/JSA.0000000000000370. Epub 2023 Dec 18. PMID: 38109164