The rotator cuff, also known as the hood or rotator cuff, is a group of tendons and muscles surrounding the head of the humerus. They are responsible for the stabilization of the humerus and movement in the shoulder joint (brachio-scapular). The rotator cuff consists of: the supraspinatus, the infraspinatus, the lesser curves and the subscapular muscle. Damage to the tendons of the rotator cuff, depending on the extent and time of the injury, may be very mildly symptomatic, but it may also lead to a very significant joint dysfunction with progressive limitation of mobility, weakness in movements of the entire limb, with pain and stiffness in the joint.
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Rotator cuff tendon injury
Rotator cuff tendon damage may be the result of trauma or the result of degenerative changes. The supraspinatus tendon is most often damaged. This muscle is responsible for the abduction movement - that is, lifting the arm sideways and low positioning of the humeral head (otherwise determining the correct rolling of the humerus head in the joint).
Tendon damage is often caused by falling on a straightened limb or when lifting a heavy object while rotating the arm. People actively practicing sports (especially those disciplines that require frequent lifting of hands, e.g. volleyball) and people who perform physical work that requires frequent repetition of the same movements, causing microtrauma and overload in the shoulder joint are also exposed to damage to the rotator cuff tendon. Sometimes, it is unfortunate enough to reach for a purse behind the car seat or abruptly move the arm away without any additional load - especially if the tendon is already degenerative at the beginning.
On the other hand, degenerative changes usually affect people over 40 and are indirectly related to the natural process of tendon wear, chronic overload at work, long-term unrehabilitated subacial tightness and other less frequent pathologies.
Symptoms of damage to the tendons of the rotator cuff
Patients who experience damage to the rotator cuff tendons experience a wide variety of ailments - sometimes with minor damage, the pain is very strong, and sometimes, despite severe damage and tearing of the tendons, the patient may not feel pain and move the limb quite freely. Often patients experience a sudden drop in muscle strength and pain, often described as stabbing, appearing in the deltoid region, sometimes radiating down to the forearm. Pain can also appear when you are resting - for example, while you are sleeping. Patients may find it difficult to move the limb, especially raising the arm.
Rotator cuff surgery (tendon stitching, reinsertion, rotator cuff reconstruction)
The physician decides about the qualification for surgical treatment of the rotator cuff, based on many factors. In the case of minor tears of the rotator cuff, patients who have failed conservative treatment are usually qualified for surgery. In the case of people who are active in sports or performing physical work, especially in the field of disciplines or professions that burden the shoulder, even "minor" damage should be repaired.
In the case of significant damage to the tendons of the rotator cuff, failure to perform surgery may lead to a gradual significant and permanent limitation of mobility and chronic pain, regardless of the lifestyle.
Rotator cuff surgery most often involves reinserting a detached tendon or several tendons to their original attachment site.
This can be done in several ways, but the most common is arthroscopic surgery using anchors with non-absorbable threads that are screwed into the bone. Removal of these implants at a later stage is not performed.
It is important that the operation is performed as soon as possible after the injury. Over time, the tendons contract and the muscles gradually deteriorate. These changes are irreversible and after exceeding certain criteria, which are assessed by MRI of the shoulder, the taper tendon repair procedure becomes impossible to perform.
Types of rotator cuff surgery
The most frequently performed shoulder surgical techniques include:
classic (open) reconstruction of the rotator cuff,
minimally invasive rotator cuff surgery - mini-open,
arthroscopic removal of calcifications of the rotator cuff,
arthroscopic reconstruction of the rotator cuff.
Open reconstruction of the rotator cuff
It is the most invasive technique, but allows for very precise suturing of the tendons. It is most often used when arthroscopic reconstruction is not possible, or by surgeons who do not deal with arthroscopic surgery. Sometimes he chooses this method of supply during arthroscopy, when it turns out that it is not possible to sew the tendons well enough only through the small holes arthroscopically.
Operation "mini-open"
This technique is less invasive than open reconstruction. The surgeon makes an incision of 3-5 centimeters through which tools are inserted, with the help of which the tendon is repaired. Before that, some activities may be performed arthroscopically. After such a procedure, the healing and rehabilitation progress is comparable to the procedure performed exclusively arthroscopically, because the skin is cut only in the place where it is necessary to sew the tendon. The operation lasts much shorter than the open surgery and the earlier arthroscopy gives a much better view of the joint cartilage and labrum, which cannot be seen during open reconstruction. However, it is not always possible to use this method. Mini-open procedures are performed only for the purpose of acromioplasty and suturing of the rotator cuff tendons.
Arthroscopic reconstruction
During arthroscopic reconstruction, the joint is filled with physiological fluid, then optics (arthroscope) and small surgical tools dedicated to the shoulder are inserted through small tools. This technique is the least invasive and allows for faster rehabilitation after surgery.
The end results of the treatment are the same for all three methods. It happens that, after a thorough arthroscopic exploration of the shoulder, the surgeon decides to proceed to mini-open surgery.
Arthroscopic removal of calcification of the rotator cuff
If the cause of the ailments is not trauma but calcified tendonitis of the rotator cuff, arthroscopic calcification is performed. In cases where the removal of part of the calcification causes damage to the tendon, it is also necessary to suture it.
Preparation for surgery
Preparation for surgery is a standard procedure - read Preparation for surgery.
Procedure after surgery
Pain medications are used to minimize pain after surgery. Swelling in the area of the shoulder joint disappears quite quickly, usually up to 48 hours, which is related to the close proximity of large blood vessels and the heart. Cold compresses can be used to reduce swelling and a feast of pain. The limb is stabilized with an orthosis or a sling. An important part of the treatment of the rotator cuff is rehabilitation. The patient should take it before surgery - rehabilitation preparation significantly improves the process of regeneration and return to full fitness after surgery, and often allows avoiding surgery.
Rehabilitation after surgery
In the first day after the surgery, rehabilitation begins - the physiotherapist teaches the patient the correct movement patterns, thanks to which he can safely use the limb and not expose it to damage. After the operation, the limb is immobilized with a sling or orthosis - however, the patient should perform wrist and finger exercises during this time. In the following weeks, the physiotherapist performs exercises with the patient to mobilize subsequent muscles. During the first 6 weeks, the purpose of rehabilitation is to protect the joint and learn to move the limb in a safe way.
The patient primarily performs exercises to mobilize the shoulder blade. At this stage, you should not rotate the limb outward or perform active movements in the shoulder joint, as this may damage the place of stitching the tendons of the rotator cuff. However, you can perform active elbow, wrist and finger exercises - this will avoid muscle contracture. After 6 weeks, the orthosis is removed and the patient can do active exercises. During this time, most patients can, for example, drive a car or work at a computer. The physiotherapist recommends exercises that mobilize the shoulder blade, strengthen the deltoid and rotator cuff muscles, as well as active and passive exercises in the shoulder joint.
After 12 weeks, there is usually a strengthening phase - the patient should still not overstrain the limb, but can function normally. Exercises with light weights are introduced into therapy, aimed at strengthening the muscles. However, it should be remembered that the patient should also exercise at this stage in accordance with the recommendations of the physiotherapist so as not to damage the tendon that is recovering.
Important information
| Duration of the procedure (depending on the method) | 60 - 120 minutes |
| Basic tests required for the procedure | basic - preparation for surgery tab |
| Anesthesia | axillary or general block |
| Hospital stay | 8 - 12 after surgery |
| A period of significant dysfunction | 2 - 3 weeks |
| A period of limited dysfunction | 3 - 12 weeks |
| Removal of stitches - first visit | 12 - 16 days |
| Change of dressings | every 3 - 4 days |
| Contraindications to the procedure | infections, old, irreparable damage (over 2 years) |
Frequently asked questions about rotator cuff surgery:
The rotator cuff, also known as the hood or the rotator cuff, is a group of muscles that surround the head of the humerus. They are responsible for the stabilization of the humerus in the acetabulum of the scapula and for movements in the shoulder joint (mainly abduction movements and rotations).
Tendon damage is often caused by falling on a straightened limb or when lifting a heavy object while rotating the arm. People who actively practice sports (especially those disciplines that require frequent lifting of hands, e.g. retina) and people who perform physical work that require frequent repetition of the same movements, causing microtrauma and overload in the tendons of the rotator cuff, are also exposed to damage to the rotator cuff tendon.
Patients experience a decline in muscle strength and pain, often described as stabbing, appearing around the top of the shoulder and sometimes radiating down to the forearm. Pain can also appear when you are resting - for example, while you are sleeping. Patients may find it difficult to move the limb, especially raising the arm to the side.
Patients who are usually qualified for the surgery are those who have not been successful in conservative treatment, as well as those who are active in sports, in whom damage to the rotator cuff is the result of acute trauma. The surgical procedure is also indicated when the damage is so extensive that it prevents normal functioning and may contribute to the formation of secondary overload changes in the shoulder.
The operation of the rotator cuff usually consists in suturing - with the use of special anchors and sutures - the tendons in their anatomical position.
The treatment may include the following methods:
classical (open) reconstruction of the rotator cuff
minimally invasive rotator cuff surgery - mini-open procedure
arthroscopic removal of calcification of the rotator cuff
arthroscopic reconstruction of the rotator cuff
