Our Summary

This research paper discusses the frequent use of shoulder arthroscopy and rotator cuff repair techniques by orthopaedic surgeons. It explains that through a proper patient history and physical examination, a rotator cuff tear can be diagnosed and the severity of the injury can be determined using imaging.

The paper suggests that rotator cuff repair is appropriate for a painful shoulder that does not respond to non-surgical treatment. Different techniques can be used during the surgery to decrease tension on the repair area and increase the success of the repair. For medium-sized tears, a specific technique called a double-row transosseous-equivalent rotator cuff repair is recommended, as it has shown excellent results. However, for larger tears, oblique convergence sutures and a medial single-row rotator cuff repair might be more effective.

The paper also emphasizes the importance of several factors in all rotator cuff repairs, such as the healing process, preservation of blood supply, and preparation of the bone for healing.

After surgery, it suggests that the repaired area should be protected with a special sling for 4 to 8 weeks. The patient should also avoid moving the shoulder actively until initial healing has taken place, as this can improve the overall outcome of the surgery.

FAQs

  1. What are the indications for a rotator cuff repair?
  2. What techniques are used in an arthroscopic rotator cuff repair?
  3. How long will I need to wear an abduction sling after a rotator cuff repair?

Doctor’s Tip

One helpful tip a doctor might give a patient about rotator cuff repair is to follow the postoperative rehabilitation protocol closely. This may include wearing an abduction sling for 4 to 8 weeks postoperatively and delaying active motion until early healing has occurred. Following the rehabilitation protocol can help ensure the success of the rotator cuff repair and improve overall outcomes.

Suitable For

Patients who are typically recommended for rotator cuff repair are those who have a painful shoulder that has not responded to nonsurgical treatments such as physical therapy, anti-inflammatory medications, and corticosteroid injections. These patients often have a confirmed rotator cuff tear, which can be diagnosed through a thorough physical examination and imaging studies.

The size and extent of the rotator cuff tear will also play a role in determining whether surgery is necessary. Medium-size tears can often be successfully repaired using arthroscopic techniques, such as a double-row transosseous-equivalent repair. Larger, retracted tears may require different surgical approaches, such as oblique convergence sutures and a medial single-row repair.

Biological factors, such as preserving blood supply and creating a proper healing environment, are also important considerations in rotator cuff repair. Postoperative care, including wearing an abduction sling and delaying active motion until early healing has occurred, can help improve outcomes for patients undergoing rotator cuff repair surgery.

Overall, patients who have persistent shoulder pain and a confirmed rotator cuff tear that has not responded to conservative treatments are often recommended for rotator cuff repair surgery.

Timeline

Before rotator cuff repair:

  • Patient experiences shoulder pain, weakness, and limited range of motion
  • Patient undergoes a physical examination to assess the shoulder function
  • Imaging studies such as MRI or ultrasound are performed to confirm the diagnosis of a rotator cuff tear
  • Non-surgical treatments such as physical therapy, anti-inflammatory medications, and corticosteroid injections are attempted to alleviate symptoms
  • If symptoms persist and the tear is significant, the patient may be recommended for rotator cuff repair surgery

After rotator cuff repair:

  • Patient undergoes arthroscopic rotator cuff repair surgery
  • Postoperatively, the shoulder is immobilized in an abduction sling for 4 to 8 weeks to protect the repair
  • Physical therapy is initiated to regain strength and range of motion in the shoulder
  • Patient gradually resumes normal activities and sports, with full recovery typically taking several months
  • Long-term follow-up appointments are scheduled to monitor the healing of the rotator cuff repair and assess the patient’s overall shoulder function and pain levels.

What to Ask Your Doctor

  1. What is the extent of my rotator cuff tear and what are my treatment options?
  2. How long will it take to recover from rotator cuff repair surgery?
  3. What are the potential risks and complications associated with rotator cuff repair surgery?
  4. Will I need physical therapy after surgery, and if so, for how long?
  5. What type of anesthesia will be used during the surgery?
  6. How soon after surgery can I return to work and normal activities?
  7. What is the success rate of rotator cuff repair surgery?
  8. Will I need any additional procedures or treatments in the future for my shoulder?
  9. What can I do to help prevent future rotator cuff injuries?
  10. Are there any specific exercises or activities I should avoid after surgery?

Reference

Authors: Gilotra M, O’Brien MJ, Savoie FH 3rd. Journal: Instr Course Lect. 2016;65:83-92. PMID: 27049183