The rotator cuff is a group of muscles and tendons in the shoulder which allow us to freely move our shoulder. Sustaining any damage to this area of the body can be cause for alarm, as injuries typically lead to intense symptoms. Pain, stiffness, and complete loss of function are some of the most alarming signs of a rotator cuff injury.
With these factors in mind, many turn to surgical intervention if their injuries are acute enough. What’s more, many of the people opting for surgery have no idea what to expect, and this can greatly reduce success rate of their treatment.
Before applying surgical means to any issue, it’s best to research and uncover as much about the problem as possible. Below, we’ve outlined some of the key points to keep in mind before going into surgery and what to expect after. Read along to learn more.
Rotator Cuff Anatomy
The rotator cuff is an interwoven system of muscles and tendons which act together to steady the shoulder and give it dexterity. Due to the numerous parts at play within the shoulder, it may be difficult to identify a single culprit behind your specific rotator cuff injury. Nonetheless, it may help you prepare for surgery if we illustrate some of these muscles and tendons and identify their purpose within the shoulder.
To begin, you should understand that the shoulder is a ball and socket joint, wherein a “ball”, in this case the head of the humerus (arm bone), rests in the “socket” of the shoulder (a bone known as the scapula).
This design allows for a high dexterity to stability ratio when combined with the numerous muscles which surround the bones and the tendons which tether the bones to the muscle.
There are seven muscles which surround the shoulder, in anatomical terms these are known as the scapulohumeral muscles. Of these seven, only four make up the rotator cuff – the supraspinatus muscle, the infraspinatus muscle, teres minor muscle, and the subscapularis muscle.
While each of these muscles allows for unique movement, they all act together to help stabilize arm and shoulder movement. The function of each muscle and its relative location is described in the table below:
Each of these muscles has its own tendon and these four tendons converge to form the rotator cuff tendon. The rotator cuff tendon is simply a fibrous sheath that attaches across the outside of the humeral head. Together with the muscles, these tendons allow us to move our shoulder through muscle constriction and relaxation.
Though each of these components can become a source of pain or dysfunction in the shoulder, the most common rotator cuff injury is a tear. These tears can occur following acute trauma or may be due to degenerative effects overtime. Whatever the case may be, patients will feel a drastic reduction in range of motion, pain, swelling, and instability following a rotator cuff tear.
These symptoms may improve overtime, though tears will remain present and as they deepen, will begin to express themselves more aggressively.
Rotator cuff injuries are most common in people who express repeated overhead motions or engage in activities which require forceful pulling maneuvers. Athletes, drummers, and blue-collar workers whose jobs entail long bouts of physical exertion involving the shoulder are most susceptible to these types of injuries.
While physical therapies have been shown to improve function in some people, if damage is acute enough, surgery is required. Regardless, any form of treatment should begin with a proper diagnosis.
Diagnosing Rotator Cuff Tears
After any acute injury or at the onset of the above-mentioned symptoms, it may be best to have a trained health team perform a diagnosis of your rotator cuff. These assessments can help a person prevent further damage and ensure that proper treatment takes place.
Initial Check Up
Doctors will run a routine medical background check to uncover any past trauma which may be causing symptoms and follow this up with a physical examination.
Physical examinations for rotator cuff tears are simple – doctors will stretch the arm and shoulder to the outer limits of their range of motion and palpate the area to uncover any peculiarities. These tests will help doctors pinpoint an exact location for the tear in order to help assure the medical imaging tests cover the correct portion of the shoulder.
If the initial tests confirm that there is a deeper issue, doctors will move on to a range of imaging tests. These tests will provide an inside view of the structures within the shoulder and give doctors more insight into what may be causing the problem. Standard imaging tests include:
- An MRI: Using radio waves and magnetic fields, doctors can take detailed pictures of your shoulder.
- X-rays: Will show doctors whether the humeral head is pushing into the rotator cuff space and creating the symptoms of a rotator cuff tear.
- Ultrasound: Allows doctors to check the soft tissues (muscles and tendons) in your shoulder.
When combined, these tests should confirm the doctor’s suspicions and lead them to the best course of action for treating your rotator cuff issue.
If a rotator cuff tear is found, and the injury is acute enough, doctors will recommend surgical intervention. While rotator cuff surgery is fairly common and comes with minimal risk, many people are still unprepared for what to expect.
In order to ensure the most success post-surgery, it is best to get an idea of the steps included before, during and after the procedure.
Rotator Cuff Tear Surgery Recovery Timeline
Surgical intervention for rotator cuff tears is minimally invasive. The shoulder is far enough away from vital organs that risk factors are low and recovery is fairly short. Though a patient may be able to return to work and daily activity immediately (1 to 2 weeks) following surgery, they will in no way have full function of their shoulder.
Though many factors as to the success of surgery are outside of the scope of the patient, there are many ways they can prepare for surgery which will make the entire process smoother. Below, we’ve outlined some critical points on the surgical timeline and what to expect at each of the crossroads. These points are in no way all encompassing, so be sure to ask your medical team for further guidance when preparing for your rotator cuff surgery.
- Preparing for Rotator Cuff Tear Surgery: Successful surgeries begin with adequate preparation. These preliminary steps help ensure patient safety and may be critical in determining the outcome of the hip replacement.
- Make sure you understand the type of surgery you are going in for – partial repair, degenerative reconstruction, or complete removal / replacement surgery. Each variety of surgery will require different preparatory steps, procedures, and recovery periods.
- Make sure you understand where the surgery will be taking place – each of the tendons involved in rotator cuff movements can become dysfunctional on their own or may break down in groups. The more tendons effected by an injury, the longer a procedure will take.
- Schedule bloodwork to reduce outside risks such as aversion to anesthetics or uncover any unknown blood or autoimmune disorders.
- Arrange for a ride to and from the hospital. Patients undergoing rotator cuff tear surgery will be prescribed medications which may prevent them from driving, it is best to have options when going to and from the hospital.
- Prepare a small parcel of luggage for about two- or three-days’ worth of trip. Toiletries, entertainment, and clothes may be necessary for the hospital stay.
- Follow your doctor’s orders to a tee. If they give a timeline to refrain from eating or drinking, it is important to follow these guidelines as anesthetics may interfere with the body’s natural digestive processes leading to complications during surgery.
- Maintain an adequate sleep schedule to boost the body’s resilience to post-surgical pain and amplify its healing processes.
- Once all preparatory steps are complete, make sure to check into the hospital in a timely manner to ensure doctors have enough time to go through their pre-surgical procedures.
- The Procedure: Rotator Cuff tear surgery is typically performed through the aid of minimally invasive tools such as an arthroscope. Surgery may take a couple of hours, after which doctors will monitor the patient’s vital signs to ensure the body responded to surgery well.
- Patients are typically placed under anesthetic until they fall asleep before surgery.
- If damage is minimal, doctors will begin the surgery with small incisions in the shoulder followed by the insertion of a tiny device known as an arthroscope. The arthroscope creates small tunnel which burrows through the knee, pushing away surrounding tissues.
- The doctors can place several small tools within the arthroscope to both see what they’re working on as well operate on the tissues directly.
- If the injury is more complex, doctors may opt for an open rotator cuff surgery. This will involve larger incisions and may require various muscles to be moved around in order to access the damaged area. Recovery from open rotator cuff surgery is typically longer than arthroscopic surgery due to the complexity involved.
- Depending on the condition of the rotator cuff tendons, the doctor will remove small portions of them or entire pieces if their condition is unacceptable.
- The doctor will either sew the ruptured rotator cuff tendons back together, remove degenerated portions of them and sew them back together, or remove them and replace them completely. Understanding your medical diagnosis is critical in determining how long surgery will take. The worse the condition of the rotator cuff tendons, the longer the surgery will take.
- Once surgery is finished, doctors will remove the arthroscope if one was inserted and close the incisions.
- First Few Hours After Surgery: Anesthetic will be applied routinely throughout the first few hours after the surgery. Doctors will monitor vital signs to ensure the surgery was successful. Typically, rotator cuff tear surgery is very low-risk and complications are rare.
- 1-2 Days After Surgery: Recovery for rotator cuff tear surgery is short. While regular functionality isn’t immediate, patients will be asked to move within 1-2 days after surgery.
- A physical therapist will be assigned to you and begin a routine of light exercise to help stabilize the shoulder.
- Some light weight bearing activities may be asked of you during these exercises.
- You will be released from hospital care and told to monitor your recovery at home. High fever, excessive bleeding, and escalating pain should be reported to your health care team immediately.
- One Week Post Operation: Patient activity levels will gradually be increased.
- Once the patient is home, they will be asked to follow the routines their physical therapist taught them as well as apply any medication the doctors have prescribed.
- Creams, ointments, and medication should be taken as routinely as the doctors have prescribed and activity levels should be moderate.
- Simple physical therapy such as light massage and hot/cold treatments can be applied if medication and rest does not help alleviate post-surgical pain. Consult a doctor if pain becomes excruciating or if you suffer shoulder injury immediately following replacement surgery.
- After 10 days, the stitches placed to close the wound will be removed and a light-follow up exam will take place.
- One Month Post Operation: Light activities can resume, and physical therapy may intensify.
- At this point the surgical wounds should be healed and normal activity levels should resume, albeit with minimal pain and discomfort.
- Extended use may cause flare-ups of pain, but these bouts of pain should wane overtime as the wounds fully recover.
- One Year Post Operation: By this time the surgical pains should be gone, and normal activity levels should return. While pain and discomfort may be inevitable, these pains should not be so excruciating that they prevent functionality.
- Patients should expect a reduced range of motion as well as reduced stability on the shoulder which was operated on.
- At times, environmental stresses – high elevation, humidity, excess cold / heat – will trigger pain, this is normal and should only be checked on if pain does not subside once environmental factors have been eliminated.
Before applying surgical intervention to any issue, it may be best to consult specialized medical professionals, for even if conservative treatments have been applied there may be other alternatives a patient simply will not know to consider.
One treatment which may help repair light rotator cuff tendon damage or reduce recovery periods post-surgery, is regenerative therapy.
Rotator Cuff Tear Surgery Recovery and Regenerative Medicine
Rotator cuff surgeries are subjectively successful. Some studies have shown that there is insufficient evidence to conclude that surgery is in fact more successful at treating rotator cuff tear symptoms over conservative treatments. Regardless, any rotator cuff injury will require extensive recovery periods.
Surgical intervention may require routines of medication and physical therapy as well as low activity levels immediately following the procedure.
With these side-effects in mind, many people turn to regenerative therapies in order to boost the body’s natural healing processes to after sustaining a shoulder injury.
Regenerative therapies such as stem cell and platelet rich plasma (PRP) therapy are injections of processed adult tissue such as blood, fat, and bone marrow which are meant to create an environment suitable for repair of damaged tissue.
By isolating the platelets in the blood, PRP therapies use the platelet’s natural release of chemical impulses to draw fresh tissues to the site of an injury. Additionally, these platelets latch onto the injury and use these fresh tissues to help reduce post-surgical symptoms such as inflammation and stiffness.
Stem cell therapies work much the same way. Extracting fat or bone marrow from a patient and processing these tissues in such a way that they begin to behave like pseudo-stem cells, then reinjecting these processed tissues directly at the site of the surgery can help boost a patient’s healing responses. Once inside the body, these stem cells help to nourish the surrounding tissues and provide an environment free from corrosive elements which may slow the recovery process.
By using these therapies in unison, many patients have found relief from post-surgical symptoms and found that their recovery processes take much less time.
If you would like to learn more about how regenerative therapies can help you recover from hip replacement surgery more quickly, contact the CELLAXYS offices today to set up a consultation.