Advances in Rotator Cuff Surgery
Christopher C. Schmidt, MD
Rotator cuff disease is one of the most common causes of shoulder pain, weakness, and loss of function. In fact, shoulder pain is the second-most common type of pain reported by patients in the United States, following only knee pain.
Within the last decade, improvements in the understanding of rotator cuff muscles, and the prevalence of minimally invasive tools, have helped surgeons reduce the pain and loss of function associated with a torn rotator cuff.
Rotator Cuff Anatomy
The rotator cuff consists of four muscle groups that attach to the long bone connecting the shoulder to the elbow, called the humerus.
In the front (anterior) of the shoulder, a group of muscles are responsible for internal rotation of the arm. In the back (posterior), separate muscles function as an external rotator of the shoulder.
These muscle groups work to center the humerus in the shoulder socket, and enable the arm to lift away from the body. An injury to the rotator cuff may not only cause pain, but also can prohibit the patient’s overhead arm motion.
Surgical treatment aims to reduce pain and restore adequate range of motion to the rotator cuff. Through minimally invasive arthroscopic surgery, the surgeon is able to see the extent of the tear without a long surgical incision and removal of large muscles.
The surgeon will repair the torn cuff with an assortment of arthroscopic tools through small incisions. The arthroscopic approach typically provides greater pain relief and restoration of function than traditional open surgery.
Full recovery from rotator cuff surgery will typically take about six months following surgical repair. However, modified activity usually starts six weeks after surgery.
Recovery time can vary from patient to patient, and is dependent on various factors, including tear size, healing potential, and patient motivation.
In addition, it has been shown that smoking impedes muscle growth, and has an adverse effect on rotator cuff healing.
Chronic Rotator Cuff Disease
Patients can sometimes develop an acute injury that exacerbates a chronically torn rotator cuff. An MRI may reveal more severe rotator cuff muscle atrophy (loss of muscle). In this case, an arthroscopic rotator cuff repair may not be effective, or even possible.
Muscle transfer surgery, called a latissimus transfer, may help decrease the pain and restore function. The rehabilitation after a latissimus transfer can take up to one year.
Research is ongoing to improve surgical treatment of rotator cuff disorders. These present and future advances will help lessen pain, improve function, and decrease time loss from a patient’s daily life.