One of the most frequent musculoskeletal injuries is the rotator cuff injury. Sometimes this type of injury is not associated with symptoms, but usually it is quite painful. A rotator cuff tear or rotator cuff tendonitis can cause you to experience pain and weakness in the shoulder when using your arms. It can be especially painful to lift the arm higher than shoulder level. Luckily, there are a number of ways to treat rotator cuff injuries – both surgical and non-surgical. The type of injury you have, your condition, and your age will be determining factors in deciding which type of treatment is right in your situation.
There are two categories of rotator cuff injury. One is rotator cuff tendonitis. The other is rotator cuff tear. Be aware that there are several other conditions that could be the cause of shoulder pain. The only way to get an accurate diagnosis of rotator cuff injury is to see a doctor. He or she will first look at the symptoms and perform a basic physical examination. After this, the physician may use a local anesthetic that will be injected into the injured shoulder. This will help determine whether the injury is a muscle tear or tendonitis. If the injury seems to be a rotator cuff tear, the doctor may order some imaging tests. These will help confirm that the injury is a tear and isolate the location of the injury.
It is far more common for the diagnosis to be rotator cuff tendonitis; however, the treatment for tears is very similar to the treatment for tendonitis. Both can be treated conservatively with what is known as RICE therapy. That is: rest, ice, compression, and elevation. You may also want to use an over-the-counter pain medication like ibuprofen. Additionally, your doctor may give you a referral to a physical therapist to learn how to modify your movements and to get a list of exercises that may be beneficial to you. If your tendonitis pain persists, your doctor may give you injections of a steroid/anesthetic mixture. These would be administered to the joint to relieve pain.
About half the patients using this kind of non-surgical treatment experience an increase in ROM (range of motion) and a decrease of pain within 2 or 3 months. This kind of treatment has several advantages. First of all, non-invasive treatment avoids surgical risks such as infection, anesthesia complications, and permanent stiffness. Second, there is no recovery time involved. Of course, there is also a downside in that this route could lead to an increase in the size of the tear. Additionally, the patients activity level may be decreased during the healing period. And, there is the risk that a non-invasive method may simply not work. If this is the case, and the non-invasive option fails, then surgery may be the alternative. The doctor may also decide that surgery is the better option if he or she feels that the injury is severe enough to merit it as the first option.
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There are three ways to treat a rotator cuff injury surgically:
The first way is open repair surgery. When open repair surgery is chosen, the surgeon will make a full incision into the shoulder. This large incision has the potential of leaving a large scar; however, this method allows the surgeon to have a great deal of freedom of movement.
2. Mini-open repair surgery: This method is like open repair surgery, but it also utilizes arthroscopy. The advantages of this method are that it is an outpatient procedure that leaves a smaller scar.
All-arthroscopic surgery is the least invasive surgery. It is an outpatient procedure that leaves a very small scar.
The doctor will determine which procedure will work best based on the specific injury.
Happily, rotator cuff surgery is a highly successful surgical procedure. Eighty to ninety-five percent of patients who have this type of surgery report successful results, improved range-of-motion and a significant decrease in pain in six months or less.
The success of your recovery is dependent on a number of factors. Among them are, your surgeons level of expertise, your fitness level, the severity of your injury, and your compliance with your doctors instructions.
Complications resulting from rotator cuff surgery are quite rare. The most commonly experienced complication is tendon re-tear. This is only experienced by about six percent of patients. Nerve injury may be experienced by one to two percent of patients. Infection may be a problem for one percent of patients. Fewer than one percent complain of stiffness. Less than one percent may have problems with deltoid muscle detachment.
Dr. Edelson is a Board Certified Orthopaedic Surgeon specializing in sports medicine. His clinic, Sports Medicine Oregon, focuses on athletes of all ages. Click here to learn more about Dr. Edelson, Portland SLAP Tear Repairs and Portland Shoulder Injuries.
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