and Joint Replacement Dr. James W. Cahill • Dr. Paul E. Kovatis • Dr. Michael C. Distefano
Rotator Cuff Repair
About Rotator Cuff Repairs
Rotator cuff tears are a very common shoulder injury among athletes and non-athletes alike. The rotator cuff is a group of four muscles that come together as tendons to hold the shoulder in its socket. The rotator cuff also plays a critical role in lifting and rotating the arm. A tear in the rotator cuff can lead to significant pain and shoulder weakness, which may affect your ability to perform certain activities.
The rotator cuff can tear with an acute injury or repetitive stress over time. For some patients with smaller rotator cuff tears, nonsurgical methods like medications, physical therapy, and injections may help to relieve pain and improve shoulder functions. However, patients that have larger rotator cuff tears and significant shoulder weakness may need rotator cuff repair surgery. Patients whose occupations or recreational activities require frequent overhead shoulder motions may also benefit from surgery.
Dr. Cahill is very experienced in rotator cuff surgery and uses the latest minimally invasive, arthroscopic techniques. Dr. Cahill is fellowship trained in sports medicine and has over 20 years of experience in orthopedic surgery. He also works with many worker’s comp organizations in New Jersey, including Bergen Risk, Horizon Casualty Services, Liberty Mutual, and Fireman’s Fund. His goal is to help patients get back to work safely and effectively, whether they need surgery or not.
Causes & Symptoms of Rotator Cuff Tears
Rotator cuff tears can either be caused by a sudden, acute injury, or degenerative wear on the rotator cuff over time. Acute rotator cuff tears can occur with an accident like a fall onto an outstretched arm, and often occur alongside other shoulder injuries, like a shoulder dislocation or broken collarbone.
Degenerative rotator cuff tears tend to be more common than acute tears. Over time, wear on the rotator cuff causes the tendon to degenerate, leading to a greater likelihood that it will tear. Degeneration happens naturally as we age, but several factors contribute to degeneration, including:
- Repeated stress on the shoulder. Many occupations and sports activities require repetitive shoulder motions, which can put stress on the rotator cuff and cause degeneration over time
- Reduced blood supply with age. As we age, the blood supply in the rotator cuff decreases. This inhibits the body’s natural ability to repair rotator cuff injuries, leaving you more susceptible to rotator cuff tears
- Bone spurs that rub against the rotator cuff. Bone spurs can develop on the underside of the acromion bone, which may rub against the rotator cuff when lifting the arm. This repeated irritation can weaken the rotator cuff over time.
Rotator cuff tears can cause significant pain and weakness in the shoulder. Acute tears will typically result in immediate pain and weakness. Degenerative tears may have symptoms that are minor at first and gradually progress. At first, you may just feel pain when lifting your arm or lying on your side, and over the counter medications may help. Without treatment, pain and weakness can progress.
If you experience any of these symptoms, it is important to get an evaluation with a qualified medical professional like Dr. Cahill to get an accurate diagnosis and start a treatment plan.
Types of Rotator Cuff Tears
The type and severity of the rotator cuff tear will determine the type of treatment plan Dr. Cahill recommends. There are two different types of rotator cuff tears.
- Partial Tears - Partial, or incomplete, rotator cuff tears occur when the tendon is damaged and torn, but not completely separated from the bone. Partial tears may not require surgery. Initial treatments for partial rotator cuff tears may include physical therapy, injections, rest, and nonsteroidal anti-inflammatory medications like ibuprofen or naproxen. If the patient’s symptoms do not improve with conservative treatments, surgery may be recommended.
- Full-Thickness Tears - Full-thickness tears, also known as complete tears, occur when the tendon is completely separated from the bone. In most cases, full-thickness tears will require rotator cuff repair surgery.
During your examination, Dr. Cahill will determine whether the rotator cuff tear is partial or fullthickness, and recommend a treatment plan based on his findings. He will opt for nonsurgical treatments whenever possible, and will recommend surgery only in cases when he feels the patient will have the most benefit from it.
Rotator Cuff Repair Surgery
Dr. Cahill may recommend rotator cuff surgery if the tear is full-thickness, if the patient has significant shoulder pain and weakness, or if symptoms have persisted with nonsurgical treatments. Rotator cuff surgery can often be done on an outpatient basis.
If surgery is needed, Dr. Cahill uses arthroscopy to repair the rotator cuff. Arthroscopy allows Dr. Cahill to repair the rotator cuff in a minimally invasive manner, which requires much smaller incisions than a traditional open approach. This often leads to less blood loss during surgery, less pain after surgery, and a quicker recovery.
To perform an arthroscopic rotator cuff repair, Dr. Cahill inserts a small camera called an arthroscope into the shoulder joint via a small incision. The arthroscope displays images on a monitor, allowing Dr. Cahill to view and repair the rotator cuff without the need for a large incision. He then inserts surgical instruments into additional small incisions to reattach the torn rotator cuff to the bone.
Recovering from Rotator Cuff Surgery
Most patients are able to return home the day of surgery. During the procedure, Dr. Cahill administers a nerve block that lasts up to 3 days after surgery. This helps manage pain after surgery to keep patients comfortable in the initial recovery period.
For the first 4-6 weeks after surgery, the arm is typically immobilized with a sling to protect the rotator cuff while it heals. Once Dr. Cahill has advised that it is safe to begin using the arm, patients start a progressive physical therapy program. The program starts with passive exercise to improve range of motion in the shoulder and graduates to exercises that help to strengthen the rotator cuff and surrounding muscles.
It can take several months to fully recover from rotator cuff repair surgery. Most patients are able to resume all normal activities within 4-6 months of surgery.
Rotator Cuff Repair in Hackensack, NJ
Dr. James Cahill has over 20 years of experience in orthopedic surgery and is fellowship trained in sports medicine. He uses minimally invasive techniques for rotator cuff repairs to help his patients get back to their work and recreational activities safely and effectively. Dr. Cahill also works with many of the worker’s compensation groups throughout New Jersey, as rotator cuff tears are common work-related injuries. For more information or to schedule a consultation with Dr. Cahill, please call our office at (201) 489-0022.