Rotator Cuff Repair

by

Dr. Bijoy K. Ghosh

The human shoulder is a very unique joint. It is one of the most mobile joints in our body but this mobility also makes it very prone to injury. Problems may occur over time, often from repeated motions (usually overhead) or maybe caused by a sudden injury.

The rotator cuff is a powerful team of muscles and connecting tendons that attach the upper arm to the shoulder blade. The rotator cuff helps us reach, throw, push, pull and lift. Without it, the shoulder would be useless. We do not think much about our shoulders until the rotator cuff starts to hurt; then even the simplest movement can be painful. Athletes are a part of our population who put themselves more at risk to injuring their rotator cuffs, either from sudden injuries or repeated vigorous movements with their shoulders. But as people live longer and do more with their shoulders, more tend to complain of pain in this part of their bodies.

When someone begins to complain of shoulder soreness or pain, he or she usually remembers a particular activity or injury that started it and usually tries simple modes of treatment like rest, ice or heat, aspirin, Tylenol or over-the-counter anti-inflammatories. If these treatments do not help, then a visit to a family physician is appropriate.

Usually a history is taken, followed by a careful physical examination of the area concerned; a routine x-ray of the shoulder helps rule out any problems with the bones. If the person continues to have pain despite the treatments previously mentioned, then a consultation is usually requested from an orthopedic surgeon. Sometimes a physical therapist may be involved in the care of the shoulder before an orthopedic surgeon is seen. Usually therapy consists of applying local heat or cold and stretching and strengthening of the muscles around the shoulder.

At the first visit to the orthopedic surgeon, the complaints, the modalities of treatment already done and any information gathered by the family physician will be discussed as will any anticipated treatment. An MRI of the shoulder helps differentiate between inflammation and damage to the rotator cuff. Sometimes either the family physician or the orthopedic surgeon may inject the most painful spot, or trigger point, with an injection that contains steroids which help relieve the local inflammation.

If none of the above modalities help relieve the pain and weakness, the orthopedic surgeon may then consider surgery. The surgery is achieved by inserting an arthroscope (an instrument the size of a pen) to look directly into the shoulder joint. A larger incision may have to be made to do a direct repair. After surgery, the surgeon will then tell the patient if the rotator cuff had to be surgically repaired or if the surrounding tissue had to be cleaned. The procedure will also determine how the post-operative therapy is to proceed.

It is very important that the shoulder is strengthened and as much movement as possible be achieved. This takes time, patience and a lot of work by both the patient and the therapist.

We have made great strides in the diagnosis and treatment of rotator cuff problems but it is always important to remember that the best cure is prevention. Always stretch, work to keep your muscles strong and stay active but learn to use your body judiciously.

Bijoy K. Ghosh, M.D. is board-certified in Orthopedic Surgery and is a member of the consulting staff of Kent & Queen Anne’s Hospital. He earned his medical degree from the G.S. Medical College in Bombay, India and completed his orthopedic residency at the Albert Einstein College of Medicine in the Bronx.

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