Ocean County Sports Medicine Dr Joe Tauro

How are impingement and rotator cuff tears treated?

Impingement and partial thickness tears of the rotator cuff are almost always initially treated non-operatively. Full thickness tears of the rotator cuff are usually treated with an arthroscopic repair.

Most impingement patients can expect significant improvement in their symptoms with a physical therapy program and, in older patients, a cortisone injection. These results are lower in older patients and in those with large bone spurs.

When trauma causes a tear in younger patients, surgery is often the first choice of treatment. Patients with this type of injury recover best if surgery is done early. Generally, this pertains to those patients under the age of fifty with tears less than four weeks old.

Non-Operative Treatment

The goals of a physical therapy program include:

strengthening the rotator cuff tendons.
stretching and regaining lost motion caused by pain and inflammation.

allowing the humerus to be better positioned under the acromion, thus reducing compression of the bursa and cuff tendons.

External Rotation

Cross Arm Push

Standing parallel to an elastic resistance cord, the elbow should be bent 90 degrees at the side. The hand should slowly rotate away from the body, using the elbow as a hinge. Rotation should continue until the arm is in a neutral position.

The hand is placed on the opposite shoulder. The other hand is used to pull the elbow across the body until a good stretch is felt on the back of the shoulder.

Anti-inflammatory medication may be prescribed to help reduce pain and inflammation. use of ice on a shoulder with rotator cuff inflammation is also very useful. Heat on an inflamed shoulder may often make the pain worse. Many patients with rotator cuff tears can function quite well if pain and inflammation are controlled with medication and physical therapy. This is especially true for the older patient and those with low demands on the shoulder.
Dr. Tauro often recommends a steroid injection into the bursa. Cortisone, or a similar steroid, is often combined with a local anesthetic to help control the pain and inflammation of the bursa. An injection will usually give the most immediate relief of pain and can help"jump start" your physical therapy program. Steroid injections must be used with caution, however. Damage to the rotator cuff tendons may occur with more than two or three injections over several months and so Dr. Tauro will rarely give a patient more than 1 cortisone injection in a 6 month period. If pain persists, there is usually significant damage to the rotator cuff tendons which must be repaired.

Operative Treatment

Impingement

A non-operative treatment plan is often all that is necessary for most patients with impingement syndrome. However, the small percentage of patients whose symptoms have not improved after a dedicated physical therapy may be candidates for surgery. The shoulder should be reevaluated to make sure no other problems exist.

Subacromial decompression expands the space between the acromion and rotator cuff tendons. Dr. Tauro performs this procedure arthroscopically in our out-patient surgery centerDuring an arthroscopy, a tiny fiberoptic instrument is inserted into the joint. Dr. Tauro can assess and repair the damage through this scope without making large incisions. Scar tissue or bone spurs can successfully be removed with either technique. If a rotator cuff tear is found at the time of surgery, it can also be repaired if necessary.

Rotator cuff repair

Dr. Tauro is recognized as one of the original developers of arthroscopic rotator cuff repair and is national lecturer on this technique. His published results of arthroscopic rotator cuff repair show the technique to be highly successful. Most symptomatic full thickness rotator cuff tears should be repaired because small and medium size tears can progress to very large tears over time. While the repair of small and medium size tears is very successful, the repair of massive tears does not give as good a result. Arthroscopic rotator cuff repair is performed as an out-patient in our surgery center. Very small incisions are used for the insertion of a fiberoptic arthroscope and for the instruments needed to repair the rotator cuff. Often, small anchors are inserted into the bone in order to reattach the rotator cuff tendons. Dr. Tauro has also pioneered the arthroscopic repair of large or recurrent rotator cuff tears (even those from failed open surgeries). These patients will usually experience a large reduction in their pain but function, especially overhead use of the arm, will usually not return to normal.

What types of complications may occur?

Complication rates after surgery are generally low. Pre-operative antibiotics are given to reduce the slight risk of infection after surgery. Infection occurs less often when arthroscopic techniques are used. Risks of major bleeding or nerve damage are extremely small. Postoperative stiffness is a the major complication of both impingement and rotator cuff repair surgeries but is much less of a problem after arthroscopic (versus open) rotator cuff repair.