Rotator Cuff Tears
Rotator cuff tears can be from progression of impingement syndrome, where the rotator cuff tendons tear from their attachment. This usually starts with the supraspinatus and can progress to the infraspinatus or other tendons. Usually this happens over time, but can occur as a single traumatic event. Pain can be similar to impingement syndrome, and can be associated with weakness. Other problems such as labral, SLAP, bicep tendon tears, and arthritis can be present.
Non-surgical treatment is similar to impingement with activity modification, avoiding heavy lifting, over the counter medications, and physical therapy. It is important to be examined by an orthopaedic specialist, as xrays and MRI are needed to confirm the diagnosis. Often surgical repair is the appropriate option.
Arthroscopic Shoulder Surgery
Advances in arthroscopic surgery have moved these surgeries from the hospital to outpatient centers. Impingement syndrome is treated arthroscopically with a ‘subacromial decompression’. This involves an outpatient surgery using a few small incisions, and the impinging bone spur and bursa are removed.
Rotator cuff repairs are more involved, and these are also treated arthroscopically in an outpatient setting. A few small incisions are made and the rotator cuff is reattached. The recovery process involves use of a sling for 6 weeks, and a program supervised by a physical therapist usually lasting approximately 4 months.
Arthroscopic view of rotator cuff tear before and after repair