How To Treat A Torn Rotator Cuff

do you need surgery for your rotator cuff problems welcome to talking with docs I'm Dr Brad we I'm Dr Paul zzo and I'm Dr John hsto thanks for joining us thanks for taking a break from watching the fails video that you've been watching or the cute animal video and you're watching something about your health so you're doing something right we're going to talk about surgery for rotator cuff problems and we have a shoulder surgeon Dr hsto who's been kind enough to hang out with us this early morning and most importantly we have another video that talks about the non-operative side which is the vast majority of treatment for rotator cuff problems so somewhere in the range of we you say 5 or 10% end up getting surgery yes pretty low yeah so don't give up on non-operative treatment before you watch this video okay so let's start at the beginning right what what's the goal of an operation why do we start talking about surgery for rotator cuff problems so when you talk about a rotator cuff tear the tendon has pulled away from the bone okay so the goal of surgery is to bring that tendon back to the Bone and have it heal okay and are all of the tears are they all pulled off the bone or could you have a tear kind of that's not at the insertion like a like a rip in your jeans kind of thing you you can have that ins substance tear like a ripping your jeans but the vast majority kind of we treat by bringing them back to the Bone because that's the the way our techniques work you know sometimes we can just stitch up the tendon but that's that's less common and and what are the indications for surgery so when do you bite the bullet and decide yeah we're going to operate on this is it because it's TR itic versus a degenerative one or is it because we failed nonoperative management what's your kind of algorithm so if you've had a tear as a result of a fall or discrete injury that's big and that limits your motion despite a you know few months of physio we want to fix that because it's not your normal State that's more common okay but the the more common tear to begin with is the degenerative the age related tear and those are the minority of what we're fixing um because they usually get better with physiotherapy okay or physical therapy your South of the Border okay so youve failed non-operative treatment what about age is age an indication or a contraindication for surgery who does well with these yeah I no I think age is is something that every patient and Doctor have to assess between themselves uh so age is not a limiting factor of course it's less common perhaps to operate on people in their 80s and 90s with this but uh age is not a the deal is with when we're talking about surgery and we're talking about age the reason that it's important is because we're always looking at a risk benefit ratio we try to achieve benefit with surgery but if the risks get too high then the risk benefit ratio tips in the favor of not operating or operating as we chronologically increase our age our risks associated with surgery that means risk of something bad happening like a heart attack stroke or even death those go up a little bit so that's why we all always take that into account when we're trying to make a decision as to whether or not to operate on someone and I think too as we get older sometimes the tissues become not fixable and I think it's hard uh for us to accept the fact that we have a problem maybe that you can't fix but at some point you're tending us to the point where you can't fix and then we'll talk about other options so when we are talking about surgery what does it look like so do you go to sleep do you are you sedated how does it work yes so you you often would have a general anesthetic you go to sleep sometimes before surgery the anst can put some free around your neck that makes your arm and shoulder numb for the day so you need less anesthetic and you wake up and you might not have any pain at first um so a after you go to sleep we clean your shoulder very carefully in an operating room uh and we usually uh can do it either arthroscopically Keyhole surgery with small incisions maybe four to six CM incisions around the shoulder or you can have a moderate sized open incision where you you know just retract the tissues and and have a bigger exposure okay what's your preference arthoscopic yeah you get a better view um smaller incisions uh you can treat other problems at the same time would you say that the literature for says for outcomes that they're comparable though they are certainly comparable yes if you address the problem in a good way and have good therapy you're going to have good success okay all right so you've got the arthoscopic version or the open version either way both results are pretty good your you're going to have surgery are there any risks associated with surgical intervention or rotator cup pathology important question yeah so if we want to say specific to the rotator cuff you know sometimes there's a chance that like like you're saying is sometimes we can't pull the tendon back sometimes the tissue is too thin we grasp it and it won't hold the sutures there's a chance that it might not heal uh in the in the in the when the conditions aren't favorable and uh and of course we're going to expect that you're going to have pains sometimes it's a lot of discomfort um if you're not taking the right steps or or using the right tools afterwards your shoulder can get stiff uh and occasionally that stiffness gets significant okay and then of course you the the sort of risk associated with any surgical procedure heart attack stroke death blood clot infection pneumonia bad things can happen but we do take precautions to really minimize a chance of something like that happening yeah for sure so now you've had surgery what's our what's our plans on I'm going to try to plan with my family or my friends or whoever is going to be helping me do I do I go home the same day do I stay overnight what's it look like what's the recovery look like for me yeah that's a great question because the recover is long so sorry you're going to spend probably six weeks in a sling I tell people you can take it off for bathing and physiotherapy um you go home the same day uh and and it can be difficult just like when your shoulders sore beforehand it can be difficult to do simple things like getting dressed bathing working all of these things are a challenge what is the purpose of the sling so I'll be like do I really need this sling the sling is to protect the repair so whenever you're moving or or or readjusting your position in bed for example that's stressing the repair and since the repair takes 3 months to heal you know much of its strength not all of its strength the sling is designed to protect it for that duration and also increase the awareness of the people around you that you know you need some protection we have that battle in just about every muscular sceletal part we've got to give time for the part to heal and then we're going to make it super stiff because we've immobilized it then we're going to get the physical therapy and the physiotherapy going to get it moving again same thing with the shoulder we're going to make you stiff because we got to let the stuff heal and then we got to get you moving again after with some kind of exercises which hurts so when it comes to therapy I think there's two different schools of thought there's the early versus the delayed mobilizers and whether it's active or passive can you talk a little bit about what you think is right and obviously every patient and every surgery is a little bit different yeah I think that you know being in a sling and seeing a physiotherapist physical therapist is the most important combination because they can help you navigate are you getting stiff can are you doing protected motion so so doing protected motion you know sometimes we talk about active assisted like your muscle is doing it and you're helping it and so you know what's feeling right for you so some early active assisted motion is definitely part of it how early like like day two day okay so real just so people know yeah absolutely so so it's about protecting it in a mindful way so seeing your physical therapist before surgery can help make a plan your surgeon will have a protocol that will talk about what they think is best and then they'll make maybe make adjustments based on how the surgery went okay part of that surgery is there also a decompression component to that surgery in addition to just repairing that tendon there's also been some bony work that's right often yeah so there's two kind of main add-ons one sometimes the roof of the shoulder we call it the acromium sometimes it's got a hook shape and so it can be pressing down on the rotator cuff and if that's the case usually we're going to trim that bony Hook off so it's not pressing and irritating the tendon um and the other major add-on is addressing the long head of the biceps tendon which passes right through the shoulder joint it's very often torn so you've got to have a plan for that because that can be a component of your pain so that's why some that's why it hurts more than just stitching the tendon back together there's Sometimes some bony work or some other tendon work as well okay you said it takes a long time to recover what are we talking about for getting back to work and getting back to sports or recreational activities I think that if you can do your job in a sling and you can get to your job then maybe you could be doing it within two to six weeks perhaps okay if you depend on moving and lifting and you're more active at your job in terms of physical labor um it's going to be quite a bit longer you know like 3 to 6 months potentially yeah 3 to 6 months I think the wor worst you know plan or the longest delay and return to work is if you'd have to do heavy or overhead things I think it could be up to 6 months in that circumstance depending on your terar keep in mind you probably couldn't do that type of job before you had the surgery anyways because you're in such rough shape with your shoulder that's true okay we always like to talk about success rates so is this an operation that even works patients are like ah this is trying to sell you surgery yeah it it it definitely works um when you look at the numbers if you you know get into the science and the research you're going to see success rates that go from 20% to 90% And that's because some tears are 6 cm and some are 6 mm and some have been there for you know 6 weeks and some of them been there for 6 years so it's a mixed bag I think if you're getting timely attention and you're having uh you you know an before surgery and your your surgeon does these regularly I think the success rate is quite High okay good okay and is it the kind of thing where it's like okay I had it on one shoulder guaranteed I'm going to get in the other shoulder or is it just not guaranteed that it's going to happen to the other shoulder it's not guaranteed at all I mean certainly there's a likelihood I wouldn't say it's high I would say maybe 20 to 30% might have a similar problem yeah okay one more scenario I want to discuss so you have a massive tear then a long time you've been told Hey sir we cannot fix this tear I'd say 20 years ago that person was kind of stuck they got like a half shoulder replacement maybe it didn't work very well but now there's potentially an option that can solve this problem can you talk to that a little bit we we got a few options depending on your age and circumstances but you know sometimes bringing in some additional tissue if the rest of the tissue is okay and you desire a high activity level you're young and healthy uh it's got a mixed R like your own like part of your lad or something like that yeah yeah bringing in a different tendon or sometimes tissue from a donor it's not a home run by any chance but it might be the right circumstance for a few patients okay um and then as we get older things like a joint replacement become even more favorable because we know it's going to last the rest of your life and the healing time actually from a shoulder replacement or the recovery is both more predictable and perhaps even a bit shorter than fixing repairing the tendon which is a bit surprising to most and what what gets you one of the things you can see to jump to that is the shoulder itself The Joint itself is now damaged because of this chronic rotator cuff insufficiency yes and you've got actual damage in the joint now because if you got a really damaged joint repairing the tendon is not going to help you significantly at that point we've got to start looking at a replacement of the whole shoulder is it just a regular shoulder replacement if you have a totally deficient rotator cuff so we call it a reverse shoulder replacement and we've got another video you kindly did a video with us on that exact we'll put a link link now you know so tons of different options for surgical treatment of rotator cuff problems but I'd say the take-home message is first stick with the non-op this is a very high chance of getting you through this difficulty and getting it back to function but if you don't you have now can talk to your family doctor or potentially get referred on to a specialist to talk to the details of potential surgical options yeah if you swiped on to this video first please swipe back go back and watch the one where we talk about nonoperative treatment because that's by far the most common way to treat a rotator cup pathology this is just in those cases where that's just not working okay now you know and if you like this video please like it subscribe to our Channel and remember you are in charge of your own health thanks Dr hsto again thanks for having me thanks for joining us John we'll see you next time

Channel: Talking With Docs

Views: 14,170

Keywords: rotator cuff, rotator cuff surgery, rotator cuff tear, rotator cuff repair, rotator cuff surgery recovery, rotator cuff repair surgery, rotator cuff injury, rotator cuff (anatomical structure), surgery, shoulder surgery, rotator cuff recovery, rotator cuff surgery rehab, rotator cuff surgery post-op, torn rotator cuff, rotator cuff exercises, arthroscopic rotator cuff surgery, rotator cuff surgery recovery timeline, hospital for special surgery

Id: S82Y2KoZU58

Length: 12min 49sec (769 seconds)

Published: Wed Feb 28 2024