What is the Rotator Cuff on the Shoulder?
The rotator cuff, which is located in the shoulder area and plays an important role during shoulder movements, consists of the combination of four basic muscles. These muscles; supraspinatus, infraspinatus, teres minor and subscapularis. This muscle group starts from certain areas of the shoulder blade, surrounds the shoulder blade, and attaches to the protrusions on this bone with its tendons. The main purpose of the rotator cuff is to regulate shoulder movements and ensure joint stability by keeping the shoulder blade in a central position in the shoulder socket. This muscle group works actively when the shoulder moves or rotates in any direction and supports the healthy function of the shoulder. Therefore, the health and functionality of the rotator cuff is critical for comfortable shoulder movements.
What is Shoulder Rotator Cuff Tear?
The rotator cuff on the shoulder provides shoulder movements thanks to its high functionality. However, over time, tears may occur in the tendons of these muscles or in the areas where the tendons connect to the shoulder head. These tears can develop due to two main reasons: age-related degeneration and trauma. With age, rotator cuff tendons can naturally wear out and weaken. This situation can cause tearing even with minimal strain, especially in elderly individuals. On the other hand, in young individuals, rotator cuff tears occur more often due to traumatic events, that is, an accident, sudden movements during sports, or direct blows to the shoulder. Such tears can restrict shoulder movements and cause pain, so early diagnosis and treatment is important.
What are the Symptoms of Shoulder Rotator Cuff Tear?
The most prominent complaint in individuals with a rotator cuff tear is usually pain in the shoulder area. This pain can often radiate from the outer area of the shoulder to the elbow. The characteristic of the tear is that this pain usually becomes more intense at night. Symptoms of the tear include limitation of movement in the shoulder, discomfort in shoulder movements, and weakness in the arm. Individuals may experience pain or difficulty doing activities on their heads. For example, placing or removing something on a shelf. Depending on the size of the tear, some patients may have difficulty bringing their hands towards their back. Especially in large or full-thickness tears, shoulder movements may be further restricted and individuals may experience extreme difficulty and weakness when lifting their arms.
How is a Rotator Cuff Tear Diagnosed?
Clinical evaluation of patients who consult an orthopedic specialist with suspicion of a rotator cuff tear usually begins with a physical examination. The doctor evaluates the shoulder’s range of motion, the function of the rotator cuff muscles, and potential signs of weakness. The patient is talked about the symptoms he/she experiences, the difficulties he/she encounters in daily activities, and possible trauma history.
As a first step, x-rays may be used to evaluate bone structures and detect other possible problems. However, magnetic resonance imaging (MRI) is the most commonly used method to see the size and location of the tear more clearly. Shoulder ultrasonography (US) can also be used to detect tears in superficial structures and often provides information about the size and nature of the tear.
A neck examination may also be required to determine whether the pain is originating from the neck area. In this way, it is possible to distinguish between neck problems and shoulder problems. As a result, a combination of clinical examination and advanced imaging techniques are used to make a complete and definitive diagnosis.
What are the Treatment Methods for Rotator Cuff Tears?
Treatment of rotator cuff tears may vary depending on the severity of the tear, the patient’s age, activity level and general health. Tears are basically classified as partial and full thickness.
In partial tears, the first approach is usually conservative treatments. These treatments; It includes cold compress applications, painkillers and rest to reduce pain and inflammation. In this process, physical therapy and specific shoulder exercises are added to strengthen the tendon and surrounding muscles. In some cases, Platelet Rich Plasma (PRP) or stem cell injections may also be used to promote tissue healing. If complaints persist despite conservative treatments, surgical intervention may be recommended.
In full-thickness tears, it is less likely to respond positively to non-surgical treatments, but they can still be tried. Non-surgical methods may be preferred initially, especially in elderly individuals and individuals with low activity levels. However, these patients need to be under close follow-up due to the progression of the tear and possible complications (further stretching of the tendon, intramuscular fat accumulation). If there is no response to conservative treatments or if the tear progresses, surgical intervention should be performed. Surgical treatment aims to repair the tear and regain the function of the shoulder.
How is Shoulder Rotator Cuff Tear Repair Surgery Performed?
With the advancement of technology, repair of shoulder rotator cuff tears is now mostly performed with arthroscopic surgery. The arthroscopic approach is a minimally invasive procedure and allows the patient to recover faster. In this method, a special position is taken for the patient’s shoulder using general anesthesia. The shoulder joint is accessed through small incisions of approximately 1 cm. A thin camera (arthroscope) and surgical instruments that view the inside of the joint are inserted through these incisions.
Torn or damaged areas inside the joint are enlarged and clearly displayed by this camera. The detected rotator cuff tear is treated using special surgical materials. To replace the torn tendon, tiny screw-like anchors are placed in the bone. Thin threads coming from behind these anchors are passed through the tendon area where the tear is located and the tendon is reattached to the bone.
The advantage of arthroscopic shoulder surgery is that less tissue is damaged and the incisions are minimal. This allows patients to experience less post-operative pain, undergo a faster recovery process, and regain shoulder function more quickly.
Healing Process After Shoulder Rotator Cuff Tear Repair Surgery
After rotator cuff tear repair surgery, patients’ recovery process usually progresses step by step. The patient is usually discharged one day after the surgery. During this period, a special shoulder strap is usually used for 4-6 weeks to keep the shoulder stable and the repaired tissue to heal in place. During this period, hand and wrist exercises are recommended to increase the mobility of the arm.
At the end of the first 10 days, the stitches in the surgery area are planned to be removed and the patient is allowed to take a shower. For the first few weeks after surgery, shoulder movements are usually limited to avoid damage to the repaired tendon. However, after this period, it is possible to increase the range of motion with exercises determined according to the patient’s condition. This period may be longer in the treatment of very large tears.
6 weeks after surgery, patients are usually referred to a physical therapy program. During this process, individualized exercises are performed to improve the movement of the shoulder and increase muscle strength. The physical therapy process takes approximately 4-6 weeks and most patients can return to their daily activities at the end of this period.
Three months after surgery, it is usually safe to resume light activities and driving. However, it is generally recommended to wait 6 months for strenuous physical activities and sports. This process may vary depending on the patient’s general health, the size of the tear and the success of the surgery.
Omuz Rotator Manşet Yırtığı Ameliyatı Hakkında Sıkça Sorulan Sorular
The duration of rotator cuff tear surgery may vary depending on the size and complexity of the tear, but generally takes between 1-2 hours.
Patients are usually discharged the next day after surgery. However, in some cases, longer hospital stays may be required.
Return to light daily activities is usually possible within 2-4 weeks. However, it is recommended to wait 3-6 months for heavy physical activities.
The success of the surgery is high depending on the surgeon’s experience, the size of the tear and the general health of the patient. Most patients experience relief from pain after surgery and a significant improvement in shoulder movements.
Physical therapy usually begins 4-6 weeks after surgery. However, this period may vary depending on the size of the tear and surgical intervention.
It is usually safe to return to sports within 6 months after surgery. However, this may vary depending on the sport.
Untreated rotator cuff tears can cause continued pain and further decline in shoulder function over time.