Shoulder injuries can result in rotator cuff tears of various sizes, which influence the operative result. The time from injury to presentation to a shoulder surgeon is fate determining in influencing final outcome. An acute tear, presenting to the shoulder surgeon within 6-8 weeks, has a much better outcome that one presenting thereafter. At ROC, we treat nearly all rotator cuff tears using minimally invasive arthroscopic methods.
In shoulder surgery, we classify tears based on time to presentation. A tear that presents within 6-8 weeks is termed an acute tear. This type of rotator cuff tear has the best outcome.
Acute on Chronic Tear:
When a patient has an injury in the past and is functioning well with only mild pain, a second minor injury changes that situation. This is called an acute on chronic tear and may create difficulty for a surgeon working to produce a good outcome.
Chronic tears are the most difficult rotator cuff tears to repair. This is because the torn shoulder tendon retracts from its attachment to bone. The muscle begins to shorten and die (atrophy), making it non-functional. In addition, scarring occurs, preventing the surgeon from stretching the tendon to bring it back to its original place of insertion.
It is always best to fix a rotator cuff tendon tears as early as possible. It is important for your surgeon to know how to treat your condition arthroscopically (through small incisions and a camera) for best results. The reasons arthroscopy provides the best results are:
- Procedure uses small incisions, which create much less scarring.
- Patient experiences less pain and requires less tissue healing time.
- Arthroscopy allows your surgeon to see better and deeper. This allows easier and more effective release of the scar around the muscle and tendon.
- An MRI does not see as well as an experienced surgeon. Therefore, even if not found before surgery, additional problems will be fixed at the same time through the camera.
These images show a patient with right shoulder pain and weakness after a minor lifting injury. Her MRI found a retracted, atrophied (dead muscle) rotator cuff tear. You guessed it; she has an acute on chronic rotator cuff tear. She had the surgery completely through the camera and small incisions. After the surgery, our goal is:
- Protect the repair while it heals.
- Maintain motion initially and during healing.
- Gradually strengthen the rotator cuff guided by the quality of the muscle, tendon and bone, size of the tear, age of the patient and whether they smoke.