Different factors determine treatmentIf a tear in the rotator cuff has been diagnosed, there will of course be different therapeutic approaches to consider based on the severity of the damage and extent of the shoulder injury. So selecting the right type of treatment will depend on how the injury occurred, how much this restricts you and how much independence you want, among other things. Your age also plays an important role. For younger patients or more recent tendon tears, the stability of the shoulder is typically restored through surgery. But because wear-related rotator cuff defects often occur in older people and sometimes only cause mild symptoms, extensive reconstruction will need to be carefully considered,
along with your individual life circumstances, everyday requirements and sports activities.
Conservative treatment methods
Conservative treatment through immobilisation and medicationWith conservative treatment, the focus is on temporary protection, decongestant and painkilling medication, localised applications of ice or heat and special physiotherapeutic exercises. Through this, we can achieve a situation where the patient is pain-free or has reduced pain, with as much shoulder functionality as possible. You can preserve the mobility of your shoulder in the early stages using arm pendulum exercises (rotator cuff exercises). If any swelling occurs, our therapists relieve this using special hand movements (manual lymph drainage). In addition, additional physical applications such as massages or electrotherapy can support the healing process.
Surgical treatment methods
Implantation of a total reverse shoulder replacement: reduction of pain and restoration of active movementIf the joint shows damages on the surface alongside the rotator cuff tear, the humerus head under the shoulder cap will have the same lack of function as the shoulder joint. In this case, implantation of a reverse shoulder replacement is a good alternative, especially for patients aged over 65. Modern reverse shoulder replacements can often be anchored to the humerus while preserving the bone structure without the use of cement or a shaft, and are inserted through a 7 to 8 cm long incision that protects the soft tissue. 85% of these implants currently have a lifetime of 15 years, but there are also replacement options. The benefit of these implants is the relatively short after-care duration. Because no tendons need to grow back, you’ll be able to have good mobility in your shoulder joint again three to six weeks after surgery.
The hospital stay lasts four to seven days. You’ll start passive movement exercises to quickly regain joint mobility straight after the procedure. Inpatient or outpatient rehabilitation treatment is recommended after three to four weeks.
Muscle-tendon transfer as a mechanical replacementAnother option for closing tendon defects that can no longer be repaired is a muscle-tendon transfer. Here, a back muscle tendon (latissimus transfer) is placed from the front-inner part of the upper arm to the top-outer part. However, only patients under 60 are able to retrain this muscle for its new function to a good extent, and the after-care and restoration of activities takes a very long time: three to six months.
Artificial tendon replacement (SCR): patching the tendon defectIf the rotator cuff defect is too large, the tendon pulled back too far and the muscles too fatty and degraded, the tendon tear won’t be able to close up successfully. This creates the risk of no longer having a centring function and of the humerus head sticking out under the shoulder cap, limiting the function of the shoulder.
In such cases, up until the last few years, the only option was to implant a reverse shoulder replacement. But because the lifetime of this replacement is limited, this procedure was postponed, especially for younger patients under 60 who were still very active physically.
In the last few years, however, a technique has been developed that has already demonstrated very good mid-term results. This involves closing the tendon defect using a type of patch. Foreign skin from the tissue bank is suitable for this patch, but one of the body’s own surface tendons of the thigh is also increasingly being used as this is four times more similar to the substance of the rotator cuff. This is removed through two 3 cm long incisions of the thigh, which doesn’t cause any pain for patients.
Arthroscopy and open surgery of the shoulder – both are possibleWe can treat a rotator cuff tear using either the keyhole technique (arthroscopy) or open surgery. Both procedures can also be combined. This way, we can protect the torn tendon parts and safely reattach them as part of a quick surgical procedure.
With arthroscopy, we operate on your injury using a small (minimally invasive) skin incision, protecting the tissue as much as possible. Because the surgical wound is only very small, less scarring forms and the healing process is very quick. Furthermore, we can precisely assess the extent of the damage in your shoulder joint during this procedure and carry out additional treatment steps as needed.
Rotator cuff tear surgery: making your shoulder pain-free againIf conservative treatment has no chance of success, we’ll need to repair the damaged structures in your shoulder through surgery. This is the only way we can prevent further damages in the joint. Our joint specialists proceed with the operation using minimally invasive methods where possible. With arthroscopy, for example, only very small skin incisions are required. This way, we can treat the injury to your joint while also continuing to preserve your tissue.
Before deciding on rotator cuff tear surgery, we always have an open conversation with you. Why? Surgical restoration of the rotator cuff often involves lengthy after-care. It typically takes several months before the operated tendon tissue heals again. Surgery therefore always creates restrictions in your working life.