Our Summary

The rotator cuff, a group of muscles and tendons in the shoulder, can suffer from various issues, including inflammation or tearing. Two common methods to examine these problems are MRI (Magnetic Resonance Imaging) and ultrasound, and the preferred method can vary based on what’s more accessible or common in a specific location.

MR arthrography, a type of MRI where a contrast material is injected into the joint to provide a clearer image, is often used after surgery to help identify any ongoing issues. When a doctor is examining an MRI before surgery, they look out for several specific details like the size and location of the tear, how much of the tendon is involved, and the overall quality of the tendon. They also look for signs that might indicate a less successful surgery outcome, such as muscle wasting, a reduced gap between the shoulder blade and the upper arm bone, or signs of arthritis in the shoulder.

Radiologists who specialize in the musculoskeletal system should be aware of the different surgical techniques and what the repaired rotator cuff should look like on an image. Imaging can also help identify if the tear has occurred again, if the graft (transplanted tissue) has failed, if the surgical hardware has loosened, if there’s an infection, or if there are other complications.

FAQs

  1. What imaging techniques are commonly used for the evaluation of rotator cuff pathology?
  2. What key findings should be included in the preoperative MRI report for rotator cuff pathology?
  3. What role does imaging play in identifying complications after rotator cuff repair surgery?

Doctor’s Tip

A doctor might advise a patient undergoing tendon repair to follow their postoperative rehabilitation plan closely, including physical therapy exercises to help strengthen and restore flexibility to the repaired tendon. It is important to avoid overexertion or sudden movements that could put strain on the healing tendon. Patients should also follow any restrictions on activities or lifting weights as recommended by their healthcare provider to prevent re-injury. It is important to communicate any concerns or pain to their doctor during the recovery process for proper monitoring and adjustment of the treatment plan if needed.

Suitable For

Patients who are typically recommended tendon repair are those with rotator cuff pathology, including tendinopathy or tearing. This may include individuals who have persistent pain, weakness, and limited range of motion in the shoulder. Patients with significant rotator cuff tears that are causing functional impairment or affecting daily activities may also be candidates for tendon repair. Additionally, patients with traumatic injuries or sports-related injuries that result in rotator cuff tears may benefit from surgical intervention. It is important for patients to undergo imaging studies, such as MRI or ultrasonography, to accurately assess the extent of the tear and determine the best course of treatment.

Timeline

Before tendon repair:

  1. Patient experiences pain, weakness, and limited range of motion in the affected joint.
  2. Patient undergoes imaging studies such as MRI or ultrasonography to assess the extent of the tendon injury.
  3. Surgeon evaluates the imaging findings and determines the need for surgical intervention.
  4. Patient undergoes tendon repair surgery to reattach or reinforce the damaged tendon.
  5. Postoperative rehabilitation program is initiated to promote healing and restore function.

After tendon repair:

  1. Patient experiences postoperative pain and swelling in the surgical site.
  2. Patient participates in physical therapy to regain strength and range of motion in the affected joint.
  3. Follow-up imaging studies may be performed to assess the success of the tendon repair.
  4. Patient gradually resumes normal activities and sports, following the guidance of the healthcare team.
  5. Long-term follow-up is necessary to monitor for any recurrent tearing or complications related to the tendon repair surgery.

What to Ask Your Doctor

  1. What is the extent of my tendon injury and what are my treatment options?
  2. What are the potential risks and complications associated with tendon repair surgery?
  3. How long is the recovery process and what can I expect in terms of post-operative pain and rehabilitation?
  4. Will I need physical therapy after the surgery and how long will it last?
  5. Are there any restrictions or limitations on my activities after the surgery?
  6. What is the success rate of tendon repair surgery and what are the factors that can affect the outcome?
  7. How long will it take for me to fully regain strength and function in the repaired tendon?
  8. Are there any alternative treatments or therapies that I should consider before opting for surgery?
  9. What can I do to prevent future tendon injuries or re-injury after the surgery?
  10. How often should I follow up with you after the surgery for monitoring and evaluation of the healing process?

Reference

Authors: Fitzpatrick LA, Atinga A, White L, Henry PDG, Probyn L. Journal: Semin Musculoskelet Radiol. 2022 Oct;26(5):585-596. doi: 10.1055/s-0042-1756167. Epub 2022 Dec 19. PMID: 36535594