Treatments and drugs

By Mayo Clinic Staff

Conservative treatments — such as rest, ice and physical therapy — often are all that's needed to recover from a rotator cuff injury. If your injury is severe and involves a complete tear of the muscle or tendon, you might need surgical repair.

Medications

If conservative treatments haven't reduced your pain, your doctor might recommend a steroid injection into your shoulder joint, especially if the pain is interfering with your sleep, daily activities or exercise. While such shots are often helpful, they should be used judiciously as they can contribute to weakening of the tendon.

Therapy

Physical therapy exercises can help restore flexibility and strength to your shoulder after a rotator cuff injury.

Surgery

Surgical options may include:

  • Bone spur removal. If an overgrowth of bone is irritating your rotator cuff, this excess bone can be removed and the damaged portion of the tendon can be smoothed. This procedure is often performed using arthroscopy, where a fiber-optic camera and special tools are inserted through tiny incisions.
  • Tendon repair or replacement. Many times, a torn rotator cuff tendon can be repaired and reattached to the upper arm bone. If the torn tendon is too damaged to be reattached to the arm bone, surgeons may decide to use a nearby tendon as a replacement.
  • Shoulder replacement. Massive rotator cuff injuries associated with severe degenerative joint disease (arthritis) of the shoulder may require shoulder replacement surgery. To improve the artificial joint's stability, an innovative procedure (reverse shoulder arthroplasty) installs the ball part of the artificial joint onto the shoulder blade and the socket part onto the arm bone
Transcript

The rotator cuff is a group of muscles and tendons that hold the shoulder joint in place and allow you to move your arm and shoulder. Problems occur when part of the rotator cuff becomes irritated or damaged. This can result in pain, weakness and reduced range of motion.

Sometimes one or more tendons become detached from the bone. In some cases, a surgeon can reattach the tendon to the bone using a thread-like material called a suture.

But sometimes the tendon is too badly damaged to be reattached. In that case, the surgeon may consider a "tendon transfer." This is a procedure in which a tendon from a different location is used to repair the rotator cuff.

The tendon most commonly transferred is the latissimus dorsi tendon in the back. For a latissimus dorsi transfer, the surgeon makes two incisions: one in the back and one in the front of the shoulder.

In the back, the surgeon detaches one end of a latissimus dorsi tendon and attaches a suture to that end. In the front, the surgeon creates a flap in the deltoid muscle, which covers the shoulder. He or she inserts a tool to grasp the end of the latissimus dorsi tendon. The surgeon brings the tendon under the deltoid to its new position.

Sutures are used to connect the transferred tendon to any remaining rotator cuff as well as bone. The surgeon tightens the sutures to pull the tendon against the bone and ties it securely in place. In some cases, anchors are inserted into the bone to help hold the sutures in place.

The surgeon closes the flap in the deltoid muscle. The incisions are then closed in the front and back.

Transcript

The rotator cuff is a group of muscles and tendons that hold the shoulder joint in place and allow you to move your arm and shoulder. Problems occur when part of the rotator cuff becomes irritated or damaged. This can result in pain, weakness and reduced range of motion.

Sometimes a bone spur forms on a shoulder bone called the acromion. "Subacromial" refers to the space beneath this bone. A bone spur in this location irritates and frays the rotator cuff tendon directly underneath. To relieve pressure on the tendon, a "decompression" procedure may be performed.

Often, a surgeon can accomplish this with an arthroscopic procedure — inserting a camera and tools through small incisions. This operation is called an arthroscopic subacromial decompression. The surgeon grinds down the spur and smoothes the bone. He or she may also clean the frayed portions of the tendon by shaving them.

Transcript

The rotator cuff is a group of muscles and tendons that hold the shoulder joint in place and allow you to move your arm and shoulder. Problems with the rotator cuff may cause weakness or pain and restrict movement. It may also cause damage to the shoulder joint.

Often, tendons can be repaired. However, if the tendons are severely damaged, an operation called reverse shoulder replacement may be a better way to improve the joint's function and reduce pain, especially if the joint is affected by arthritis.

This operation is also called reverse arthroplasty. "Arthro" means joint; "plasty" means to mold surgically.

The top of the arm bone fits into a socket on the shoulder blade. In a typical shoulder replacement, a plastic lining is attached to the socket to allow smooth movement. The surgeon removes the top of the arm bone and inserts a metal stem with a ball on the end. However, if the rotator cuff is severely damaged, the joint may not be stable or work properly.

In a reverse shoulder replacement, the normal ball-and-socket structure is reversed. An artificial ball is attached to the shoulder blade. An artificial socket is attached to the top of the arm bone. The large deltoid muscle that covers the shoulder is typically able to move the arm.

General anesthesia will be given so you will sleep through the surgery.

An incision or cut is made in the front of the arm and shoulder. The surgeon separates muscles and cuts through tissue to expose the joint.

The upper arm bone is removed from the socket. The top of the arm bone is cut off and prepared to receive an artificial part. The socket is also prepared. A plate is screwed to the socket and a half-sphere attached. The metal stem is inserted in the arm bone, and a plastic socket is attached to the top.

The new socket is fitted against the new ball to allow smooth movement. The tissue is sewn together around the joint, and the incision is closed.

Feb. 19, 2014

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