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Rotator Cuff Injury

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From Mayo Clinic staff

Treatment

Mayo Clinic is a nationally recognized leader in treatment of rotator cuff injuries. Mayo is involved in research and innovative, new treatment options, particularly for rotator cuff injuries with severe tears or damage. Mayo's medical team coordinates care among multiple medical experts to ensure that each patient's problem is thoroughly evaluated and that all treatment options are considered so the most appropriate health care can be provided. Treatment options include rehabilitation, which involves exercises and motion analysis, medication, surgery, and postsurgical care.

Rehabilitation

Mayo Clinic's state-of-the-art rehabilitation program provides patients with various therapeutic options, including:

  • Physical therapy — body movements or exercises designed to improve flexibility of the rotator cuff and shoulder muscles, and provide balanced strength in the shoulder muscles. Specific exercises for other parts of the body may be necessary to ensure that force is effectively transferred during a specific sport movement and that the shoulder is not excessively stressed. Depending on the severity of the rotator cuff injury, physical therapy may last from three weeks to several months.
  • Motion analysis — evaluation of how the patient's sports activity, job tasks or other physical activity may be causing the rotator cuff injury and development of activity modifications and exercise interventions that reduce stress and strain on the rotator cuff.
  • Recovery from surgery — physical therapy and patient education in home exercises and ways to prevent the rotator cuff injury from recurring.

Medication

Patients with severe and persistent pain from rotator cuff injury may benefit from a corticosteroid (a form of steroids) injection. The medication, which may be injected around the affected muscles, helps reduce pain, swelling and inflammation.

Surgery

Surgery may be the best option for patients who have rotator cuff tears or those who have not had success with nonsurgical treatment. Several types of surgery may be performed, including subacromial smoothing (decompression); rotator cuff repair; tissue transfers; and, in cases of severe arthritis, partial or full shoulder replacement (hemiarthroplasty and reverse ball-and-socket).

Subacromial Smoothing (Decompression)

In this procedure, the orthopedic surgeon removes inflamed tissue and bone spurs from the area around the rotator cuff. At Mayo Clinic, this surgery is done using arthroscopic (minimally invasive) techniques. The procedure is performed on an outpatient basis, the healing time is shorter than traditional surgery, and the patient experiences less pain.

Rotator Cuff Repair

In this procedure, the torn tendon is reattached to the arm bone. This procedure can be done using open (traditional surgery) or arthroscopic surgery. In either procedure, the surgery may be done on an outpatient basis. Mayo Clinic anesthesiologists use regional anesthesia with pain-control catheters. This allows patients to return home the day of the surgery, usually with little discomfort.

Tissue Transfers

In some cases, rotator cuff tears are too large to be repaired, and Mayo Clinic orthopedic surgeons transfer other tissue (soft tissue flaps, muscle tissue) to substitute for the damaged rotator cuff. Mayo Clinic is involved in ongoing research to develop new ways to repair rotator cuffs which have severe tears or damage.

Partial or Full Shoulder Replacement (Hemiarthroplasty and Reverse Ball-and-Socket)

Shoulder replacement may be needed for patients with longstanding rotator cuff tears who develop a unique form of arthritis (rotator cuff arthropathy). Partial shoulder replacement (hemiarthroplasty) is a traditional treatment.

Mayo Clinic is one of the first medical groups in the country to offer full shoulder replacement using a device, developed in Europe and recently approved by the U.S. Food and Drug Administration for use in the United States, the reverse ball-and-socket shoulder replacement. The reverse ball-and-socket allows patients who have rotator cuff arthropathy and significant muscle weakness to once again raise their arms overhead.

Recovery from Rotator Cuff Surgery

Following surgery, the patient begins a individualized physical therapy program based on the surgery performed and the condition of the bone and soft tissue. Patients will need to continue to rebuild their strength for up to a year after surgery, but many patients can return to activities, such as golf or tennis, in four to five months after surgery.

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