Rotator cuff tears increase with age and are particularly common in people over the age of At the same time the ability to get the rotator cuff to heal after a repair decreases as we age. Many people use this information to argue that patients over the age of 70 should not have a rotator cuff repair. However, an article in the May issue of the Arthroscopy Journal See Article demonstrated good results following a rotator cuff repair patients over the age of The authors reviewed rotator cuff repairs and compared results in patients aged 60 to 69 to those aged 70 to Importantly, all patients attempted 6 months of conservative treatment i.
You can do your daily activities. You don't want to do the physiotherapy program required after surgery. You have other health problems that may make surgery too dangerous. How does physiotherapy help treat rotator cuff disorders? If your shoulder joint capsule or tendons are tight, physiotherapy can help improve your range of motion and allow your shoulder to move more smoothly. Physiotherapy may strengthen the muscles that move your arm and shoulder.
Physiotherapy helps you learn how to lift and carry objects and do other activities using the muscle groups that aren't hurt. This puts less stress on your injured rotator cuff tendons.
Why might your doctor recommend rotator cuff surgery? Your doctor may recommend rotator cuff surgery if: You are young and your tendon tissue is strong and healthy.
There is a good chance that your tear will get worse over time. You had a forceful injury to your shoulder, such as during an activity or car crash. You have severe shoulder pain or weakness. You have not gotten better after 3 to 6 months of other treatment and physiotherapy. Compare your options. Compare Option 1 Have rotator cuff surgery Try other treatment.
Compare Option 2 Have rotator cuff surgery Try other treatment. Have rotator cuff surgery Have rotator cuff surgery You are asleep or numb during surgery.
If you have subacromial smoothing or rotator cuff repair using arthroscopy , you will likely go home the same day that you have surgery. If you have rotator cuff repair using open surgery, you will likely go home the same day that you have surgery. Your arm will be in a sling for several weeks. After either type of surgery, you will do range-of-motion exercises to loosen up your shoulder.
Then you'll continue physiotherapy for up to 8 weeks. It may take a few months to recover. You get relief from your pain. You have improved shoulder strength and movement. Surgery may not restore full strength to your shoulder. You may need more physiotherapy or another surgery. Other risks of rotator cuff surgery include: Pain or stiffness that won't go away. Nerve damage. All surgery has risks, including the risks of bleeding and infection and risks related to anesthesia.
Your age and your health can also affect your risk. Try other treatment Try other treatment You rest your shoulder. Gentle movement is recommended so your shoulder doesn't get stiff. You try ice packs to reduce pain and swelling. You try using moist heat during gentle shoulder movement. You take anti-inflammatory medicines to relieve pain. You try physiotherapy to help you learn how to lift and carry objects.
You avoid the risks of surgery. You avoid having surgery that you don't need if rest and physiotherapy improve the use of your shoulder. You can have surgery later if other treatment doesn't work. If you have severe shoulder weakness, rest and physiotherapy alone may not help. Without any treatment, rotator cuff disorders may get worse.
Over time you may have more pain and may lose range of motion and strength in your shoulder. Personal stories about having rotator cuff surgery These stories are based on information gathered from health professionals and consumers. What matters most to you? Reasons to have rotator cuff surgery Reasons not to have rotator cuff surgery. The risk of surgery doesn't bother me. I'm worried about the risks of surgery. The benefits of surgery outweigh the risks for me.
I don't want to have surgery for any reason. My other important reasons: My other important reasons:. Where are you leaning now? Having surgery Leaning toward NOT having surgery. What else do you need to make your decision?
Check the facts. Yes You're right. Surgery may be a good idea if you tore your rotator cuff in a sudden injury and the tear is making your shoulder weak. No Sorry, that's wrong. But surgery can't fully reverse problems that occur over time from wear and tear. I'm not sure It may help to go back and read "Get the Facts. But it can't fully reverse shoulder problems that occur over time. You may be able to limit early rotator cuff damage with rest, ice and heat, medicines to relieve pain and swelling, and physiotherapy.
No Sorry, that's not right. If you have symptoms that don't get better after 6 months of rest and physiotherapy, surgery may help. Decide what's next. Yes No. I'm ready to take action.
I want to discuss the options with others. I want to learn more about my options. Your Summary. Your decision Next steps. Your knowledge of the facts Key concepts that you understood. Key concepts that may need review. Getting ready to act Patient choices. What matters to you. Print Summary. Patients can return to active use quickly; the exercises are directed at maintaining range of motion and building strength in the muscles and tendons that remain intact.
Surgery should be strongly considered in the situation when sudden weakness follows a shoulder injury and when an examination and ultrasound or MRI shows a rotator cuff tear with reasonable remaining tissue for a repair. In shoulders with the gradual onset of shoulder weakness and without a significant injury surgery can be considered if a stretching and strengthening exercise program does not yield the desired improvement. Preoperative ultrasound or MRI along with a careful examination can suggest whether a repair is likely to be possible or if a smooth and move is likely to be the procedure of choice.
Patients who use narcotic medication or who use tobacco are generally not candidates for this procedure. Success requires good quality tissue a healthy patient technical excellence of the surgery and a steadfast commitment by the patient to the rehabilitation program prescribed by the surgeon. As for all elective surgical procedures the patient should be in the best possible physical and mental health at the time of the procedure. Any heart lung kidney bladder tooth or gum problems should be managed before surgery.
Any infection may be a reason to delay the operation. Any skin problem acne scratches rashes blisters burns etc on the shoulder or arm should be resolved before surgery. The shoulder surgeon needs to be aware of all health issues including allergies as well as the non-prescription and prescription medications being taken. For instance aspirin and anti-inflammatory medication may affect the way the blood clots.
Some of these may need to be modified or stopped around the time of surgery. Rotator cuff surgery is a surgical procedure that may result in pain immediately after surgery — this is especially the case of the repair of a major cuff tear much less with a smooth and move procedure. Pain from this surgery is managed by the anesthetic and by pain medications. Immediately after surgery strong medications such as morphine or Demerol are often given by injection.
Within a day or so oral pain medications such as hydrocodone or Tylenol with codeine are usually sufficient. The patient is encouraged to be up and out of bed soon after surgery and to progressively reduce their use of pain medications.
Hospital discharge usually takes place on the second or third day after surgery. After a rotator cuff repair patients must not raise their arm actively that is without assistance for weeks or months following the procedure as specified by the surgeon. During this healing time the arm is protected in a sling. Patients are to avoid lifting more than one pound pushing and pulling for six weeks after surgery.
Driving is not recommended for the first six weeks after surgery. Thus the patient needs to be prepared to have less arm function for the first month or so after surgery than immediately before surgery.
For this reason patients usually require some assistance with self-care activities of daily living shopping and driving for approximately six weeks after surgery. Management of these limitations requires advance planning to accomplish the activities of daily living during the period of recovery. After a smooth and move procedure active use of the shoulder is initiated immediately after surgery in that there is no concern about overstressing a repair. The rate of progression from that point is determined by the surgeon in light of the quality of tissue found at the time of surgery.
Once the shoulder has a nearly full range of motion strength and comfort the patient may progressively resume activities. It is important to recall however that even with a solid and complete repair and with good healing the tendon will remain susceptible to re-injury for up to a year after surgery.
Like all surgeries rotator cuff surgery can be complicated by infection nerve or blood vessel injury fracture instability and anesthetic complications. Furthermore this is a technically exacting procedure and requires an experienced surgeon to optimize the bony prosthetic and soft tissue anatomy at the procedure.
The most common causes of failure are 1 failure of a rotator cuff repair to heal or 2 scar tissue that limits the range of motion after the procedure.
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