Injuries and Conditions: Rotator Cuff Injury : Rotator Cuff Injury :
Most patients with a diagnosed rotator cuff tear will not require surgical treatment. Injuries to the rotator cuff can range from mild tendonitis to a complete tear.
Initial treatment for a rotator cuff injury is rest and anti-inflammatory medication, mainly to control pain. While a true rotator cuff tear will not heal, some partial tears may not significantly disrupt shoulder function and may not require a surgical repair. In cases where the tear is severe, surgery should be considered.
A mild to moderate rotator cuff injury will not require surgery and is commonly treated with non-steroidal anti-inflammatory drugs (NSAIDs), ice packs, rest, and activity modification and participation in physical therapy rehabilitation program.
The identification of the activity which caused the injury, and the modification of that activity in the future, will help in the healing as well as the prevention of a more severe tear in the future.
A complete tear in the dominant arm of younger, active patients will probably require surgery. This is because a tear in the rotator cuff will not repair itself.
The purpose of surgery is to relieve the symptoms and to repair the injured structure responsible for causing the symptoms. Rotator cuff surgery can be performed either by the traditional "open" procedure or arthroscopically. The surgeon will use either technique to view the shoulder structures and to remove damaged tissue and bone. If a partial or complete tear is identified, the margins of the tear will be re-approximated and sutured together.
Patients are given a complete physical examination that provides an assessment of the patient's overall health.
The degrees of flexion, extension and the range of motion is established for each shoulder.
Diagnostic imaging studies will be performed to pinpoint the exact location of the rotator cuff injury.
Immediately after surgery, as anesthesia wears off, patients will usually feel tired, slightly disoriented and nauseated, though the after-effects of anesthesia can vary greatly from patient to patient.
Post-operative pain will be present and may require over-the-counter or prescription medication to control the pain.
Passive range of motion exercises are begun on the first post-operative day to regain shoulder flexibility.
Postoperative instructions:
Activity
Follow general post operative guidelines.
Be wary of any signs of infection which are fever, redness at the incision site and severe pain.
No driving until instructed by your physician.
Do not engage in activities which increase pain or swelling that are not part of the physical therapy program.
Maintain your arm in a sling at all times until instructed otherwise by your physician.
Ice Therapy
Begin ice therapy immediately after surgery.
Use a cryocuff continuously or as tolerated for the first week after your operation or until your follow-up appointment with your doctor. If you have not been instructed to use a cryocuff, manual icing should be performed every two hours for twenty minutes until your swelling is controlled.
The initial rehabilitation includes sling immobilization with short periods of passive motion. Passive motion moves the shoulder without muscle contraction. Following the initial post-operative period, active assisted and solo exercises should be started. Participation in activities that strengthen, tone and condition the shoulder is critical to a successful recovery and the prevention of future injuries to the shoulder. Strong shoulder muscles reduce the strain on and help stabilixe the other structures of the shoulder.
A full recovery is achieved when the injured shoulder has reached the post operative maxium range of motion without pain and has regained normal strength compared to the uninjured shoulder. This may take up to one year or more depending on the severity of your initial injury. It is important to note that it may not be possible to obtain complete range of motion in the injured shoulder.
Participation is a customized physical therapy program which measures improvements in motion.
Good or excellent results are achieved in 80 to 90 percent of patients undergoing surgical repair.
There is a chance that the cuff may re-tear after repair. Most people that experience a re-tear do not require repeat surgery.
Risks during and after surgery include problems that may develop in relation to bleeding, infection, and/ or anesthesia.
Injury to blood vessels and nerves within the shoulder.
Full motion of the shoulder may not return.
Continuing pain may be present within the shoulder.
The cuff may not heal or may re-tear.
Rest and Activity Modification: Initial treatment for a rotator cuff injury should begin with and include rest and a reduction in activity. The avoidance of all overhead activities is recommended.
Medication: Over the counter or prescription medications, including NSAIDs will help to reduce the inflammation and swelling of the shoulder muscles.
Cold and Heat: Ice applied to the injured shoulder is an excellent way to reduce inflammation and pain. Alternating between heat and cold, following an initial treatment with just cold, can further help in releaving the pain.
Injections: Moderate to severe cases may be treated with an injection of a corticosteroid into the bursa between the cuff tendon and the acromion bone.
A rehabilitation program involving physical therapy is suggested after the initial shoulder symptoms have subsided.
NSAIDs NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) are a group of drugs used to control pain. This category of medications includes both prescription and common over-the-counter painkillers such as ibuprofen. NSAIDs are effective for many types of pain that can occur because of inflammation of muscles, joints and bones. The drugs work quickly and people often notice some benefit within a few hours of taking the tablet. However, the complete effectiveness of the drug may not be realized for up to four weeks. For each individual, some varieties of NSAIDs are more effective than others. Often, patients will find that one or two varieties are helpful whereas others may not be as effective in controlling symptoms. It is usually necessary to try several brands and continue with the one that is most suitable. NSAIDs can be used to treat:
Pain resulting from inflammation or swelling.
Pain after injury.
Joint pain and arthritis.
| Hot/Cold Pack The use of hot and cold packs to relieve pain and inflammation is a common method of treatment for many conditions. When the soft tissue groups become strained or irritated the rotating application of hot and cold can be beneficial.
Cold therapy numbs the nerves to reduce pain and combats swelling by constricting blood vessels and by slowing blood flow to the site of injury. The application of heat to an injury after a few days of cold therapy and after swelling and redness has been reduced promotes the healing process.
Heat therapy speeds up healing by increasing the flow of blood to the site of injury. Heat will also restore flexibility, relieve muscle cramping, and arthritic symptoms.
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Patients who follow the recommended course of therapy, should expect a complete recovery within six to twelve weeks. With a severe shoulder injury where tearing of the tendon has occurred, scar tissue may remain and full range of motion may never be obtained.
Patient's goals, expectations, and lifestyle may need to be altered, with normal activity levels being modified.
A complete recovery is dependent on the severity of the injury, the health and habits of the patient, the pre-injury condition of the shoulder, and the patients compliance with a prescribed physical therapy program or other conditions present.
Maintaining an active exercise program, which includes stretching and strengthening of the shoulder muscles to avoid stiffness and weakness is recommended. Adhesive capsulitis (Frozen Shoulder syndrome) may result if exercise is avoided.
Poor muscle conditioning or nutrition may increase the risk for further injury or prolong your recovery time.
Improper lifting of heavy objects following an injury, may inhibit healing or result in further injury to the tendons.
The participation in sports involving repetitive motion of this arm and shoulder may predispose the rotator cuff to further injury.
There can be a recurrence of symptoms even after successful non-surgical treatment.
Various types of metal, plastic or absorbable anchors may be utilized to repair a rotator cuff tear.
This procedure does not require a transplant or graft.
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