Rotator Cuff Repair

• Rest and activity modification to avoid aggravating shoulder pain and prevent further injury
• A structured physical therapy program to strengthen the shoulder muscles, improve range of motion and restore function.
• Over the counter NSAIDs to reduce pain and inflammation.
• Heat to relieve chronic pain and stiffness. Cold to reduce acute pain.
• Steroid injections for persistent pain and to reduce inflammation. However, repeated injections are not recommended because they can weaken the tendons.

Studies have shown that non-surgical management can be an effective treatment strategy for many patients with rotator cuff tears.

If non-surgical methods do not provide relief, or if the tear is large or severe, surgical intervention may be necessary. Surgery aims to repair the torn tendon and restore shoulder function.

1. Debridement: Arthroscopic debridement involves removing the damaged tendon tissue to reduce pain and improve shoulder movement.
2. Arthroscopic Rotator Cuff Repair: This is a minimally invasive procedure where Dr. Cinque uses a small camera (arthroscope) and instruments inserted through small incisions to repair the torn tendon. This method is commonly used due to its shorter recovery time and smaller incisions.
3. Open Rotator Cuff Repair: In cases of larger or more complex tears, an open repair may be necessary. Dr. Cinque would make a larger incision to access and repair the torn tendon. While this approach allows for a more direct view of the shoulder, it usually involves a longer recovery period.
4. Mini-Open Repair: This combines aspects of both arthroscopic and open surgery. The procedure begins arthroscopically to evaluate the damage, then a small incision is made to complete the tendon repair.
5. Tendon Transfer: If the tear is too large or the rotator cuff is too damaged to repair, a tendon from another part of the body may be used to restore shoulder function.
6. Superior Capsular Reconstruction (SCR): This is a newer treatment for large, irreparable rotator cuff tears. During this procedure, a graft made from synthetic material or donor tissue is placed between the ball of the upper arm bone (humeral head) and the shoulder socket. This graft helps stabilize the shoulder joint and keeps the upper arm bone from moving upwards, which can reduce pain and improve shoulder movement.
7. Shoulder Replacement (Reverse Shoulder Arthroplasty): For massive rotator cuff tears, particularly in older patients with arthritis, a reverse shoulder replacement may be considered. This procedure involves replacing the damaged joint surfaces and reversing the mechanics of the shoulder to allow the deltoid muscle to compensate for the damaged rotator cuff.
8. Biologic Augmentation: In some cases, biologic materials, such as platelet-rich plasma (PRP) or stem cells, may be used to enhance the healing potential of the tendon tissue.

Post-treatment rehabilitation is crucial for both non-surgical and surgical treatments. Physical therapy plays an essential role in restoring shoulder strength, flexibility, and function. Recovery timelines vary depending on the treatment approach and individual patient factors, ranging from weeks for non-surgical management to several months after surgery. While full recovery may not always be possible, these interventions can significantly reduce pain, improve shoulder strength, and restore functionality.