Massive Rotator Cuff Repair

Massive Rotator Cuff Repair Surgeon

Are you an athlete who participates in sports that involve throwing overhead? If so, you may be at risk of sustaining a rotator cuff injury. A massive rotator cuff tear occurs when two or more of the tendons become damaged from repetitive overuse, a sports injury, a fall or degeneration. Orthopedic shoulder
surgeon, Dr. Nikhil Verma provides diagnosis and both surgical and nonsurgical treatment options for patients Westchester, Oakbrook, Hinsdale and surrounding Chicago communities who have sustained a massive rotator cuff tear. Contact Dr. Verma’s team today!

Massive Rotator Cuff Tear Overview

The rotator cuff is a system of tendons and muscles in the shoulder that give the joint stability and offer an incredible range of motion. The job of the rotator cuff is to provide rotation and strength to the arm, allowing it to move, lift and turn while remaining stable within the joint. The grouping of muscles come together as tendons and insert on the ball of the humerus (upper arm bone) to hold the ball of the humerus firmly in place within the glenoid (shallow socket of the shoulder blade).

A massive rotator cuff tear occurs If there is an injury to two or more of these tendons, tearing the cuff of tissue away from the attachment site on the bone. Dr. Nikhil Verma, orthopedic shoulder surgeon, is able to successfully treat patients in Westchester, Oakbrook, Hinsdale and the surrounding Chicago, IL who have suffered a massive rotator cuff tear.

What causes a massive rotator cuff tear?

Massive rotator cuff tears can occur from:

• Overuse: Activities that repeat an overhead motion can cause a massive rotator cuff tear, these overuse injuries are often seen in weightlifters, or workers whose job requires continuous motion above shoulder level. Athletes at risk for a massive rotator cuff tear from overuse include swimmers, weightlifters, gymnasts and those who participate in racquet sports.
• Age and Degeneration: As we age the tendons and muscles naturally lose their flexibility and strength. The body’s ability to heal and regenerate also diminishes and it becomes easier to injure the tendons and muscles in the shoulder.
• Injury: Massive rotator cuff tears can occur during trauma, an automobile accident, sports injury or a serious fall.

What are the symptoms of a massive rotator cuff tear?

Depending on the mechanism of injury, symptoms can be sudden and severe, or they can worsen over time. Symptoms common with a massive rotator cuff tear are:

• Significant pain, either over time or at the time of injury
• Pain that prevents sleep and worsens during the night
• Decreased range of motion
• Weakness in the arm and shoulder
• Joint tenderness
• Pain and problems reaching or lifting objects, especially overhead

How are massive rotator cuff tears diagnosed?

Dr. Verma will conduct a thorough examination, testing areas of pain, range of motion and the strength of the shoulder joint. He will inquire about the patient’s history and what led to the shoulder pain the patient is experiencing. Diagnostic tests helpful in determining if there is a massive rotator cuff tear include and MRI scan which can help Dr. Verma determine the extent of damage within the shoulder.

How is a massive rotator cuff tear treated?

Massive rotator cuff tears often worsen over time and require surgical intervention for repair. Dr. Verma prefers an arthroscopic treatment for the majority of massive tears, offering patient in the Chicago area a quicker healing time, less pain and less chance of infection. The surgery is performed using a small camera called an arthroscope, inserted into the shoulder joint through a small incision. Small, specialized instruments are also used, inserted into the shoulder through other small incisions and the repair is done inside the joint. Dr. Verma secures the torn tendons to the original attachment site using specialized surgical sutures.

What is the recovery like after a massive rotator cuff repair?

Patients heal at different rates, depending on their age, health and medical condition. Dr. Verma has an extensive recovery guideline that if followed properly, offers patients the best chance at a full recovery. In general, patients will begin passive motion exercises (someone else moving the arm) 2 weeks after surgery. Active motion exercises (patient moves their own arm) are allowed 6-8 weeks after surgery. Physical therapy and strengthening exercises can be performed after proper healing, in about 10-12 weeks and will continue until Dr. Verma releases them from care.

Massive Rotator Cuff Repair FAQ

What is a massive rotator cuff repair?

A massive rotator cuff tear occurs when at least two of the four rotator cuff tendons have torn away from or have retracted from the attachment site on the humerus (upper arm bone). A massive rotator cuff repair is a surgical treatment to repair the torn tendons that make up the rotator cuff. Tears of this nature are usually 5 cm or greater and have ruptured (completely torn) from their attachment. Dr. Nikhil Verma has extensive experience in repairing massive rotator cuff tears.

Can a massive rotator cuff tear be repaired?

Many massive rotator cuff tears are able to be repaired using standard arthroscopic surgery techniques. If the tear is small, or acute, there is a better chance of repair and the more time that passes after the tear, makes it more difficult to repair. High rates of successful massive rotator cuff tear repair occur with careful visualization, techniques for release of tissue and mobilization of the torn tendon. The use of modern surgical tools for fixation of the tendon can also add to the success of repair in the majority of patients.

In cases where the muscle is viable and the tendon can be mobilized (moved) back partially, Dr. Verma may recommend augmentation of the repair with a “patch” consisting of either allograft tissue (from a donor) or other types of collagen tissue. This can reinforce the damaged rotator cuff tissue and assist in healing. In cases where the native tendon is extensively atrophied and immobile then Dr. Verma may recommend a newer arthroscopic procedure called a superior capsular reconstruction or he many proceed directly to a reverse total shoulder replacement.

When is a massive rotator cuff tear non-repairable?

Some massive rotator cuff tears cannot be repaired. Rotator cuff muscles that no longer function, due to atrophy from a long-standing tear, may not be able to be repaired. This occurs because the normal muscle of the rotator cuff becomes weak, which is not reversible. Tendon damage that has degenerated or is weak or retracted (pulled back) may not be able to be repaired because the normal elasticity of the tendon is lost, making it difficult for sutures to hold the tendon to its anchoring spot on the humerus.

Do I need surgery to repair a massive rotator cuff tear?

Even with massive rotator cuff tears, some patients are able to achieve good results with non-surgical treatments. This may include rest, physical therapy or injections. Dr. Verma can advise patients on the proper treatment for their specific type of massive rotator cuff tear.

What is the repair technique for a massive rotator cuff repair?

Dr. Verma often uses an arthroscopic approach for a majority of massive rotator cuff tears. Arthroscopic repair involves small incisions in which a small camera and small instruments are utilized to operate inside the joint. The procedure is performed as an outpatient surgery with regional and general anesthesia.

During this arthroscopic repair surgery, the torn rotator cuff tendons are pulled back onto the bone and secured with sutures. Over time, the tendon will reattach to the bone and the patient will regain strength of the shoulder joint with supervised physical therapy.

What is the rehabilitation of a massive rotator cuff repair?

The rehabilitation for a massive rotator cuff repair will vary, based on the patient’s willingness to follow Dr. Verma’s recovery guidelines. In general, healthy patients without any underlying medical issued can expect to begin passive motion exercises 2 weeks after surgery, with active motion allowed after 6-8 weeks. Strengthening exercises can begin at about 10-12 weeks and continue until the patient is released from care.

What is the recovery time from a massive rotator cuff repair?

Recovery time will vary based on the extent of tendon damage, age and health of the patient and actual shoulder surgery performed. Typical tears can take approximately six or seven months to reach full recovery.

How many rotator cuff muscles are there?

There are four rotator cuff muscles:

• Supraspinatus: Holds the upper arm bone (humerus) in place and keeps the upper arm stable. This muscle helps lift the arm in forward flexion and is the most commonly torn tendon of the rotator cuff. (The term “tendon” describes the very end of the muscle that thickens and attaches to bone).
• Infraspinatus: The main external rotator of the shoulder.
• Teres Minor: The smallest rotator cuff muscle, it assists with external rotation and lateral motion. This tendon is rarely torn.
• Subscapularis: The large muscle which runs in front of the shoulder joint and provides force for internal rotation of the shoulder. Tears of the tendon are commonly associated with injuries to the biceps tendon including subluxation (where the biceps tendon slips into the tear).