Rotator cuff tears often require repair, and when the surgery for rotator cuff occurs, often the shoulder surgeons and the patient have had a discussion prior regarding repairability of the tear, whether or not the tear is going to heal, whether or not the muscle health (so called fatty atrophy or degradation – or in layman’s terms actual fat present in your muscle belly of the torn tendon) is sufficient, and also about size of the tear. Rotator cuff tears once big enough will be called “massive” in nature which usually means the tear is over 4 cm pulled off from its insertion site (“retracted”) and usually to the point of the cup of the shoulder (therefore putting together our science lesson, retraction to the glenoid – or cup – of the shoulder).
For example, this is an MRI of a massive retracted or torn rotator cuff tendon. Fortunately for this patient, the health of his muscle was good, so a repair was attempted. It is very important to discuss potential failure of repair, and steps involved with healing with the patients at this point.
Additionally, expectation management is crucial. But in a well indicated patient, it is reasonable to attempt repair given favorable conditions: non-smoker, healthy appearing muscle on MRI, acute or subacute nature of the tear (not a chronic or decade long tear), and over all general healthy appearance.
Intraoperatively, his rotator cuff was as expected; retracted, e.g. very far away from where it needed to be. The tendon had to be freed up from adhesions that form over time and to do this operation arthroscopically – which I only do my rotator cuff repair surgery arthroscopically (I personally have never opened a rotator cuff during repair) – and this is the most important step, frankly. Too often, I see surgeons attempt repairing without appropriate time paid to freeing up the tendon, but once that is done appropriately, the tendon becomes repairable. As it was in this case.
Ultimately after 12 sutures that we placed throughout the tendon, and sequential tying down of each portion of the tendon, it was able to be tied down anatomically:
And none of this blood sweat and tears that both the patient and I put into this will mean or represent anything if we cannot get the tendon to heal back down to its footprint. That is something that is best followed clinically; meaning, how is the range of motion and pain coming back in the shoulder. Fortunately for this gentleman, his pain went down, and by 3 months nearly had full range of motion (ROM) back in his shoulder. I normally counsel patients to expect to have this (normal ROM) by around 4-6 months. So this massive rotator cuff tear that underwent repair was slightly ahead of schedule!
Rotator cuff tears can cause severe pain and dysfunction. Often times surgeons may tell you they are irreparable when in fact they might be, the only way to tell is to place yourself in experienced, well-trained hands of a rotator cuff specialist. Alternatively, if a surgeon tells you he may have to open your shoulder (switch from arthroscopy to open) in order to repair it, it may mean that the shoulder surgeon is not that comfortable with advanced arthroscopic techniques of the shoulder. Please contact me to see if I can help your shoulder! Make an appointment today for your rotator cuff tear surgery with www.shouldermd.com Dr. Daniel Grant Schwartz M.D.
