Rotator Cuff Tear Treatment
Different factors determine treatment
If a tear in the rotator cuff has been diagnosed, there will be, of course, different therapeutic approaches to consider based on the severity of the damage and extent of the shoulder injury. Selecting the right type of treatment will depend on how the injury occurred, how much this restricts you and how much independence you want, among other things. Your age also plays an important role. For younger patients or more recent tendon tears, the function of the shoulder is typically restored through surgery. But because wear-related rotator cuff defects often occur in older people and sometimes only cause mild symptoms, extensive reconstruction will need to be carefully considered, along with your individual life circumstances, everyday requirements and sports activities.
Conservative treatment methods
Conservative treatment through immobilisation and medication
With conservative treatment, the focus is on temporary protection, decongestant and painkilling medication, localised applications of ice and special physiotherapy exercises. Through this, we can achieve a situation where you might become pain-free or have reduced pain, with as much shoulder functionality as possible. You can preserve the mobility of your shoulder in the early stages using arm pendulum exercises. If any swelling occurs, our therapists can help relieve this using manual lymph drainage. In addition, some physical applications such as massages or electrotherapy can support the healing process.
Surgical treatment methods
Rotator cuff tear surgery: making your shoulder pain-free again
If conservative treatments fail to improve the shoulder symptoms and function, we’ll need to repair the damaged structures in your shoulder through surgery. This is the only way we can prevent further damage in the joint.
Our joint specialists proceed with the operation using minimally invasive methods where possible. With arthroscopy, for example, only very small skin incisions are required. This way, we can treat the injury to your joint while also continuing to preserve your tissue reducing risk and complications.
Before deciding on rotator cuff tear surgery, we will always have a careful conversation with you as often surgical restoration of the rotator cuff involves lengthy aftercare. It typically takes several months before the operated tendon tissue heals again. Surgery therefore will create restrictions in your working life.
Arthroscopy and open surgery of the shoulder – both are possible
We can treat a rotator cuff tear using either the keyhole technique (which is most commonly used) or with open surgery. Both procedures can also be combined. This way, we can protect the torn tendon parts and safely reattach them as part of a quick surgical procedure.
With arthroscopy, we operate on your injury using several small (minimally invasive) skin incisions, protecting the tissue as much as possible. Because the surgical wounds are so small, less scarring forms and the healing process is much quicker. Furthermore, we can precisely assess the extent of the damage in your shoulder joint during this procedure and carry out additional treatment steps as needed.
The arthroscopic operation is carried out under a general anaesthetic. It is performed as a day surgery procedure in most patients. The tendon is repaired by stitching it to the bone using tiny suture anchors. The suture anchors can absorbable or non-absorbable (metallic). The arm is then placed in a sling to allow for healing.
Artificial tendon replacement (SCR): patching the tendon defect
If the rotator cuff defect is too large, the tendon pulled back too far and the muscles too fatty and degraded, the tendon tear won’t be able to close up successfully. This creates the risk of no longer having a centering function and having the humerus head sticking out of the shoulder joint, limiting the function of the shoulder.
In such cases, up until the last few years, the only option was to implant a reverse shoulder replacement. But, because the lifetime of this replacement is limited, this procedure was postponed, especially for younger patients under 60 years who were still very active physically.
In the last few years, however, some techniques have been developed that have demonstrated very good mid-term results. This involves closing the tendon defect and adding reinforcement with a type of patch. Artificial patches or foreign skin from the tissue bank can be used as well as one of the body’s own surface tendons from the thigh.
Muscle-tendon transfer as a mechanical replacement
Another option for closing tendon defects that can no longer be repaired is a muscle-tendon transfer. Here a back muscle tendon (latissimus dorsi transfer) is placed from the front-inner part of the upper arm to the top-outer part. This technique can be done arthroscopically assisted with minimally invasive approach and has shown excellent midterm results for active patients.
Implantation of a total reverse shoulder replacement: reduction of pain and restoration of active movement
If the joint shows damages on the surface alongside the rotator cuff tear, the humeral head under the shoulder cap will have the same lack of function as the shoulder joint. In this case, implantation of a reverse shoulder replacement is a good alternative, especially for patients aged over 65 years. Modern reverse shoulder replacements can often be anchored to the humerus while preserving the bone structure without the use of cement or a shaft, and are inserted through a 7-8cm long incision that protects the soft tissue. 85% of these implants currently have a lifetime of 15 years or more. The benefit of these implants is the relatively short aftercare duration. Because no tendons need to grow back, you’ll be able to have good mobility in your shoulder joint again three to six weeks after surgery.
The hospital stay lasts three to five days. You’ll start passive movement exercises to quickly regain joint mobility straight after the procedure. Inpatient or outpatient rehabilitation treatment is recommended after the immobilization period.
As with all surgery there is a risk of complications. These are rare, but you should be aware of them before your operation.
• Complications relating to the anaesthetic
• Failure to achieve a successful result.
• A need to redo the surgery
• Injury to the nerves or blood vessels around the shoulder
• Prolonged stiffness and or pain
• Implant failure
• Re-tear of the tendo