Do I Need My Rotator Cuff Fixed?
The rotator cuff is a group of 4 muscle-tendon units (subscapularis, supraspinatus, infraspinatus, teres minor) which help to move and stabilize the ball (humeral head) of the shoulder joint against the socket (glenoid). Rotator cuff tears are one of the most commonly encountered injuries involving the shoulder joint. Usually only 1-2 of the 4 tendons are involved with the tear. Most rotator cuff tears occur as a result of wear and tear of the tendon and many of them do not need to be fixed. Often times simple exercises to strengthen the intact rotator cuff tendons and surrounding muscles that support the shoulder joint is enough to relieve the pain associated with the tear and improve the function of the shoulder. Injections can sometimes be helpful, however, we typically like to avoid them if possible since there is some evidence that it may degrade the quality of the rotator cuff tissue over time.
The decision to fix a rotator cuff tear can be relatively complex as there are many factors which influence the outcome of your surgery after an attempted repair. Some of these include your age, the chronicity of the tear, the size and location of the tear, associated conditions such as co-existing arthritis, whether or not you are a smoker, and your over all health status. In addition, the rehabilitation from a repair can often be 6-9 months with limitations on the use of your arm during that period.
In our experience, the younger, the more active, and the more acute the tear, the more likely we are to recommend a repair. We are careful to counsel patients about the length and difficulty of the rehab which is important to achieving a good result from surgery. Ultimately, the decision to undergo a rotator cuff repair is up to the patient and it is the role of your surgeon to provide you with all of the information you need to make an informed decision. Below are a list of some of the factors that we consider when recommending a repair versus alternative management. Keep in mind that each patient's situation is unique and the decision to pursue a particular treatment is not black and white.
Factors Favoring Repair
- Younger age (<65 yo)
- Acute traumatic tear
- Minimal muscle atrophy and retraction (based on MRI)
- Smaller full thickness tears (based on MRI)
- No arthritis
- No stiffness
- Good overall health
Factors Favoring Alternative Management
- Older age (>65 yo)
- Chronic atraumatic tears
- Significant muscle atrophy and retraction (based on MRI)
- Small partial thickness tears (based on MRI)
- Concomitant arthritis
- Multiple failed repairs
- Multiple prior steroid injections
- Superior migration of humeral head (on x-rays)
- Poor overall health