Preparing For Rotator Cuff Injury Surgery
by Dr. Richard Edelson
Physicians see more rotator cuff injuries than almost any other musculoskeletal injury. A patient with a rotator cuff injury will experience pain and weakness in the shoulder, but not swelling. Sometimes the patient does not have symptoms. Usually, though, the patient will have increased weakness and pain when active. This is especially true when raising the arm higher than shoulder level. Fortunately, there are quite a few treatments available for rotator cuff injury. The type of treatment that is suitable would depend upon the patient’s age and the type of injury experienced.
Rotator cuff injuries occur in two ways. You could either have rotator cuff tendonitis or a rotator cuff tear. It is important to realize that there are a few other conditions that can cause the type of pain one experiences with a rotator cuff injury. For an accurate diagnosis, you will need to see your physician. The first step your physician will take is a physical examination. Following the examination, your doctor may inject your injured shoulder with a local anesthetic. This process will help your doctor in determining exactly what kind of injury you have. If your doctor decides that you have a rotator cuff tear, he or she may send you for some imaging tests. Imaging tests will help pinpoint the location of the injury and confirm whether or not the injury is a tear.
Rotator cuff tendonitis is more common than rotator cuff tear, but the treatment is similar for both. Rest, ice, compression and elevation, also known as RICE therapy, is prescribed for both conditions. Your doctor may also tell you to take an over-the-counter pain medication like ibuprofen. You may also be referred to a physical therapist who will help you to understand how to modify your activities to avoid pain and may also give you instructions on exercises to help strengthen your shoulder. If these measures dont help, your doctor may give you a shot of a steroid/anesthetic mix. This injection will be made directly into the joint to help address your pain.
This sort of non-surgical intervention usually has a 50-50 chance of being effective. If it is to work, you will probably see results in 6 – 12 weeks. Using non-invasive techniques of this sort can be good in a number of ways. When you do not have surgery, you also do not have recovery time. Furthermore, you do not experience any of the risks commonly associated with surgery such as complications caused by anesthesia, permanent stiffening of the joint, or infection. One thing to realize, however, is that this approach can cause the original tear to increase in size. Additionally, even though there is not a set recovery time, you will be operating at less than your usual ability until you have completely recovered. Aside from these considerations is the fact that non-invasive techniques may not be effective. You may end up having surgery after all. If your injury is quite severe, your doctor may bypass the non-invasive option and recommend surgery right from the start.
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There are three ways to treat a rotator cuff injury surgically:
The first way is open repair surgery. When open repair surgery is chosen, the surgeon will make a full incision into the shoulder. This large incision has the potential of leaving a large scar; however, this method allows the surgeon to have a great deal of freedom of movement.
2. Mini-open repair surgery: This method is like open repair surgery, but it also utilizes arthroscopy. The advantages of this method are that it is an outpatient procedure that leaves a smaller scar.
The third method is known as all arthroscopic surgery. This is the simplest option in that it is an outpatient procedure, and it also leaves the smallest scar.
The doctor will determine which procedure will work best based on the specific injury.
After rotator cuff surgery, most patients have decreased pain and an increase in range-of-motion. Recovery is usually complete within 4 to 6 months. Results are usually quite satisfactory, with 80 – 95% of patients reporting good results.
The success of your recovery is dependent on a number of factors. Among them are, your surgeons level of expertise, your fitness level, the severity of your injury, and your compliance with your doctors instructions.
Some patients experience complications from surgery; however, these are rare. One to two percent may experience nerve injury. Approximately one percent may contract infection. Less than one percent may have detachment of the deltoid muscle. Less than one percent may experience stiffness. Tendon re-tear is experienced by approximately six percent of patients.
Dr. Edelson is a Board Certified Orthopaedic Surgeon specializing in sports medicine. His clinic, Sports Medicine Oregon, focuses on athletes of all ages. Click here to learn more about Dr. Edelson, (http://www.orthopedicsurgeonportland.com/edelson/pages/richard-edelson-portland-orthopaedic-surgery.php) Vancouver ACL Reconstruction and (http://www.orthopedicsurgeonportland.com/edelson/pages/office.php) Vancouver Knee Doctor.
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