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Treatment of Rotator Cuff Lesions.

Last updated Wednesday, January 26, 2005

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Introduction

Good judgement on the part of the patient and surgeon is needed to plan treatment of rotator cuff tears.

About treatment

Acute tears of healthy tendons should usually be repaired promptly to restore strength and function to the shoulder. Rotator cuff surgery is particularly helpful in this acute situation. Chronic defects in weakened tendon tissue may not be repairable. Exercises or surgery to smooth the working surfaces may be preferable to cuff repair in these circumstances.

Vocational rehabilitation

Although cuff repair may increase the strength of the shoulder, our preference is to avoid having the patient return to heavy lifting, pushing, pulling, or overhead work after a major cuff repair. Thus, we attempt to initiate vocational rehabilitation as soon as the diagnosis of cuff tear is made, indicating that in spite of optimal treatment, there is a substantial risk of retearing if the repaired cuff is subjected to major loads. It is important to remind both the patient and the employer that a cuff tear usually occurs through abnormal cuff tendon. Repairing the tear does not restore the quality of the tendon tissue; thus the repaired cuff remains vulnerable to sudden or large loads.

Improving strength

Patients with rotator cuff tears may present with problems of shoulder stiffness or shoulder roughness. Here we are concerned with the potential for improving strength through rotator cuff repair. Critical determinants of the success of operative treatment are the quality of the tendon and muscle and the amount of cuff tendon tissue that has been lost. As we have seen previously, the expected strength of the cuff diminishes with age and disuse. Thus, the chances of a durable cuff repair likewise decrease in older and less active shoulders. This is particularly the case if the cuff defect has been long-standing.

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