Rotator Cuff Tears Thomas J Kovack DO Rotator

Rotator Cuff Tears Thomas J Kovack DO

Rotator Cuff Tears

Anatomy n 4 Muscles 1 in front n 1 on top n 2 behind n

Impingement

Rotator Cuff Tears

What we know… n Rotator Cuff Tears are common n By age of 60 over 50% of people have a tear n Most tears are degenerative tears n Some are traumatic n Larger tears have loss of greater shoulder function

What we know… n Rotator Cuff Tears do not heal on their own n Rotator Cuff Tears get larger over time n Some patients with rotator cuff tears do not have pain n Many patients will eventually have pain (Yamagucci, JSES 2001)

Non-operative Treatment n n n n Anti-inflammatory Medications Physical Therapy Cortisone Injections* Modification of activities 60 -70% will show some improvement Best for low demand patients Rotator cuff will not heal Bartolozzi et al (CORR 1994), Hawkins & Dunlop (CORR 1995)

Activity Levels Decision of surgery based on activity level n “Age” is relative to activity level n Goals of high activity levels n Need maximal function from rotator cuff n Consider surgery earlier n

Surgical Treatment n Options n Surgical Treatment – Rotator Cuff Repair n Opportunity to heal tendon n Arthroscopic surgery n Outpatient n Well-tolerated n Small-medium size tears have 90 -95% chance of improvement (Wolf, Arthroscopy 2004) (Gartzman, JBJS, 1998) (Tauro, Arthroscopy, 1998)

Challenges n What makes successful repair more difficult n Smoking n Diabetes n Large/Massive rotator cuff tears n 88 -95% improvement Savoie (Arthroscopy 2003), Burkhart et al (Arthroscopy 2001) n Recurrent tears n Multiple Cortisone Injections (Watson JBJS 1985)

Arthroscopic Rotator Cuff Repair n Small incisions n Arthroscope n Under Water

Arthroscopic Repair

Post-operative Rehabilitation n Phase 1 (0 -6 weeks) Shoulder Immobilizer n Pendulum exercises only n Pool therapy n

Post-operative Rehabilitation n Phase 2 (6 -12 weeks) Stretching n Sling when out of house n Begin to use arm n n Golf put, no swing n No lifting

Post-operative Rehabilitation n Phase 3 (3 months+) More vigorous activities n No strength training until 6 months n

Complications n Rotator Cuff Re-tear n 29% (Boileau et al JBJS 2005) Stiffness n Infection n Arthritis n Nerve Injury n Suture or Anchor related complications n Anesthesia risks n

Appointments Pre-operative Visit n Post-operative Visit (1 week) n 1 st Follow-up (6 weeks) n 2 nd Follow-up (12 weeks) n 3 rd Follow-up (6 months) n 4 th Follow-up (1 year) n Annual Visits n