Rotator Cuff Tear Treatment Options

For people with symptomatic tears, non‐operative management including anti-inflammatory medications, rest, icing, corticoid (Steroid) injections and physical therapies often, but not always, result in satisfactory outcomes. Conservative management is considered successful if your shoulder function and strength and symptoms are significantly improved. When a trial of conservative management fails to improve symptoms, surgery may be recommended. Importantly, tears tend to enlarge and are more difficult to treat so delaying treatment is not recommended.

Repair for large and complex tears is performed arthroscopically. Arthroscopy is used to evaluate and treat the damaged tissues including bone spurs, and tears of the bicep tendon. Then Dr. Patel will repair the rotator cuff with sutures and anchors.

The shoulder capsule is a supportive structure made of tough connective tissue that encloses and covers the shoulder joint. It is the primary shoulder stabilizer. The tendons in the rotator cuff are often under heavy strain as they stabilize the joint. With an irreparable massive rotator cuff excessive strain is placed on the capsule which can tear under the strain.

Superior Capsule Reconstruction is anatomic reconstruction of the shoulder capsule to restore normal restraints in a nonfunctioning rotator cuff. The procedure is employed to treat massive rotator cuff tears in people with little to no arthritis and a fully functional deltoid muscle.

It is an innovative technique designed to avoid shoulder replacement surgery. This procedure may be performed arthroscopically or as an open procedure. During the procedure, Dr. Patel will attempt to repair the rotator cuff to balance the normal forces in the shoulder. Then he will use a tissue graft to reconstruct the capsule which is the primary static stabilizer. The goal is to repair the rotator cuff complex to stabilize the shoulder and improve function. The procedure provides superior results in young patients as compared to reverse shoulder replacement surgery.

Massive, irreparable rotator cuff tears account for up to 40% of all rotator cuff tears. They are challenging to treat and require extensive rehabilitation. Balloon dilation is an FDA cleared balloon implant for patients with massive, irreparable rotator cuff tears and for people who have a degenerated rotator cuff that, but for this new procedure, would require extensive complex invasive procedures to restore shoulder function. Balloon dilation is a low risk, minimally invasive procedure that can provide meaningful improvements in shoulder function.

In a healthy shoulder with an intact rotator cuff, the head of the upper arm bone sits centered in its socket. When the rotator cuff tendons fail, the head of the upper arm bone drifts upward and causes the bones to contact abnormally which is very painful, and the muscles cannot work correctly. The implant, an inflatable, saline-filled balloon, is placed between the bones to separate them, and recenters the head of the upper arm bone. It requires no sutures or fixation.

After surgery physical therapy retrains the muscles to restore function. After about a year, the balloon dissolves and the muscles can take over cuff function. Advantages include shorter surgical time, faster recovery and return to work and daily activities with immediate rehabilitation.