Surgical and non-surgical treatments are the two main courses of action for treating rotator cuff injuries.
The key to non-surgical treatments is patience. It can take anywhere from several weeks to several months to get desired results.
Rest: Resting the injured joint is the first step to reduce swelling and pain. Be sure to keep using the arm gently. Keeping it immobilized can lead to a painful condition called frozen shoulder.
- Ice: In the first 24 hours of an injury, ice it to reduce swelling and pain.
- Heat: After 24 hours have passed, a heating pad or hot compress can help.
- NSAIDS (non-steroidal anti-inflammatory drugs): Reduce pain and swelling through NSAIDS such as ibuprofen (Advil), naproxen (Aleve) and aspirin.
- Physical therapy and exercise: Gentle exercises and stretches designed to strengthen the muscle can treat many rotator cuff injuries. Dr. Nicholson has found that beginning physical therapy is beneficial as soon after an injury as possible.
- Steroids: Cortisone can be injected directly into the rotator cuff to reduce inflammation and pain, but steroid injection should be used under the careful direction of a doctor, and multiple injections should be avoided.
Most rotator cuff injuries are treated non-surgically, but Dr. Nicholson may do surgery if a rotator cuff is torn or if months of physical therapy and other treatments have not helped.
Common surgeries to correct rotator cuff that Dr. Nicholson has extensive experience performing include:
Impingement Surgery (also called Acromioplasty or Subacromial Decompression)
When rotator cuff tendons get pinched between the upper arm bone and the part of the shoulder blade known as the acromion, the rotator cuff cannot move freely. The result is a damaged rotator cuff.
During the procedure, surgeons such as Dr. Greg Nicholson make more room for the tendons to move by shaving a small portion of bone from the underside of the acromion.
Any irritated bursa or bone spurs can also be removed at this time.
This surgical procedure is sometimes performed to relieve severe tendinitis. More often, it is conducted as part of typical rotator cuff repair surgery.
Arthroscopic Rotator Repair Surgery
Dr. Greg Nicholson, one of the leading shoulder surgeons in the country, has significant experience performing an innovative arthroscopic procedure that uses a minimally invasive approach to treating rotator cuff tears. Using this arthroscopic technique, Dr. Nicholson employs small instruments in combination with a tiny camera to make the repair to the rotator cuff. The difference between arthroscopic and more traditional open rotator cuff repair is the size of the incision and the tools used. (true?)
How arthroscopic rotator cuff surgery is performed:
Rather than making a large incision, Dr. Nicholson makes three small incisions.
A small, thin tube containing the arthroscope is inserted into one of the incisions allowing Dr. Nicholson to look into the shoulder and see the full scope of the tear.
By inserting special instruments through the remaining two incisions, Dr. Nicholson is then able to remove scar tissue and bone using instruments he controls remotely while watching a video screen.
Next, Dr. Nicholson prepares the humerus (upper arm bone) with a device called an arthroscopic burr that provides a surface on which the rotator cuff can heal.
After inserting small metal screws that contain sutures into the bone, Dr. Nicholson is able to carefully weave the sutures through the torn tendon to securely fasten the rotator cuff to the humerus. The screws are inside the bone and you can’t feel them. The screws do not have to be removed, and they will not set off airport sensors.
Once the tear is repaired, Dr. Nicholson will remove any bone spurs, which are common in most rotator cuff patients.
What type of anesthesia is required for arthroscopic surgery?
Both general anesthesia and regional anesthesia can be given for this type of surgery.
Regional anesthesia involves administering a block into neck nerves that make the arm go numb, often between 12 and 16 hours. This technique helps patients with pain management after surgery. Rotator cuff surgery can be painful, even when performed with the less-invasive arthroscopic method, so the regional pain block can be tremendously helpful to patients during the first 16 to 18 hour after the surgery.
What are the advantages of arthroscopy for rotator cuff repair?
Because arthroscopic surgery requires a smaller access point, the incisions are much smaller than in traditional open surgery, leading to shorter recovery time for the patient.
Smaller incisions also lead to less trauma to the deltoid muscle, which in turn leads to less post-operative pain and improved function.
What is the success rate for arthroscopic rotator cuff repair?
Arthroscopic surgery almost always succeeds in alleviating pain in the rotator cuff.
Less predictable is returning strength to the shoulder. Between 85 and 95 percent of patients have success. While no operation is 100 percent successful all of the time, Dr. Nicholson’s patients have the advantage of a highly trained, accomplished and experienced shoulder specialist who employs the most advanced technologies and brings a highly experienced team with him for each patient he treats.
However, because repairing a torn rotator cuff can be complicated, it often is necessary to perform the repair through open surgery. Orthopedic surgeons offering advanced solutions such as Dr. Greg Nicholson are best equipped to make that decision based on a patient’s individual circumstances.
How much does surgical expertise count?
Arthroscopic rotator cuff repair is a technically demanding procedure best performed by surgeons with extensive experience.
Rotator cuff surgery can be a complex procedure. In particular, repairing a rotator cuff arthroscopically can be particularly demanding. Success comes from a skilled orthopedic surgeon specifically trained in arthroscopic shoulder surgery backed by a dedicated team of anesthesia doctors and a network of skilled physical therapists who understand the principles of a successful rehabilitation program. Dr. Greg Nicholson has the advanced training and high patient volume that are crucial to achieving the best-possible clinical outcomes.
Recovering from Rotator Cuff Surgery
Immediately after surgery, the patient’s arm is put in a sling. Ice is applied for pain. Patients are encouraged to walk. The sling can be loosened to allow the elbow to straighten, but the shoulder needs to remain immobile.
Patients who had open surgery remain in the hospital one to two days. Those patients who had arthroscopic surgery typically go home the same day as the surgery.
Immobilization through the sling continues for three to four weeks, allowing the tendon to begin healing. Patients are not permitted to lift their arms on their own (fire their shoulder muscle) for the first four to six weeks after surgery.
Physical therapy plays a critical role in the recovery process as the patient works to restore range of motion. Most patients will begin having physical therapy sessions before they leave the hospital.
By week four or six, the patient will begin lifting the arm and initiating some strengthening exercises with the aid of a physical therapist.
By the third month, most patients can lift between 5 and 10 pounds overhead. They can return to most everyday activities at this point, including driving.
By 6 months after surgery, most patients have regained 80 percent of their strength. It’s important to continue physical therapy at this stage. Studies show that over the next two years, gains in strength will continue.
How important is it to keep moving the shoulder?
It’s very important to get some range of motion back to the shoulder to avoid the shoulder becoming too stiff. From the beginning, Dr. Nicholson’s skilled staff will work with you to ensure a physical therapy regimen suited to your specific recovery. Four weeks after surgery, you will begin to lift the arm with the assistance of a therapist. By three months, you’ll be able to lift the arm and begin more aggressive strengthening exercises.