What is the Rotator Cuff and What Does It Do?
The rotator cuff is a structure composed of four muscles and their tendons that surround the shoulder joint. These muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) ensure the stable movement of the shoulder. They play a critical role in fundamental functions like overhead movements, rotation, and lifting of the arm. The tendons connect the muscles to the upper arm bone (humerus), enabling these movements. This structure is the most important stabilizer that keeps the shoulder in place despite its wide range of motion.
How Do Rotator Cuff Tears Occur?
Rotator cuff tears generally occur due to two main reasons: trauma and degeneration. Traumatic tears result from a single event such as a fall, lifting something heavy, or a sudden impact. Degenerative tears, on the other hand, develop over time due to chronic causes such as aging, repetitive overhead movements (common in athletes or certain occupations), reduced blood flow, and bone spurs (osteophytes). These tears can be partial or full-thickness.
What Are the Symptoms of a Rotator Cuff Tear?
The most common symptoms of a rotator cuff tear are pain in the shoulder, difficulty lifting or rotating the arm, and a feeling of weakness when moving the arm. The pain often worsens at night, especially when lying on the affected shoulder. Simple daily activities like lifting the arm overhead can become very painful. In some cases, a catching or clicking sound may be heard in the shoulder. Symptoms vary from person to person and depend on the size of the tear.
How Is a Tear Diagnosed?
The diagnosis of a rotator cuff tear begins with the patient’s complaints and a physical examination. The doctor tests the shoulder’s range of motion and strength. Imaging methods are used for a definitive diagnosis. X-rays can show bone spurs or other structural problems but do not clearly show a tendon tear. The most reliable methods for determining the size and location of the tear are magnetic resonance (MR) imaging or ultrasonography.
Are There Cases Where Surgery Is Unnecessary?
Yes, not every rotator cuff tear requires surgery. For partial tears or small full-thickness tears, especially if the patient’s symptoms are mild and do not severely affect their daily life, non-surgical treatments can be tried. In these cases, conservative methods such as physical therapy, exercises, medication, or cortisone injections are often the first choice and can yield successful results.
What Are Conservative Treatments?
Non-surgical treatment methods aim to reduce pain and improve shoulder mobility. These treatments include rest, pain relievers and anti-inflammatory medications, applying cold or hot compresses to the shoulder, physical therapy sessions, and steroid injections. Physical therapy helps the shoulder regain its function by strengthening the muscles and increasing flexibility through specific exercises.
Is the Situation Different for Young Patients?
In young patients, rotator cuff tears are usually caused by traumatic injuries, and the tendon tissue is healthier. Therefore, full-thickness tears in young and active individuals are often stronger candidates for surgical repair. Surgical intervention may be more aggressively recommended to prevent the tear from growing and to avoid permanent loss of shoulder function. Their recovery processes are also generally faster and more successful.
What Methods Are Used for Rotator Cuff Repair?
Currently, three main surgical methods are used for rotator cuff repair: arthroscopic repair, mini-open repair, and open surgery. The most commonly preferred method is arthroscopic surgery, performed with small incisions. This method is popular because it is minimally invasive and provides a faster recovery. Open surgery may be preferred for larger tears or when there are additional problems.
What Is Arthroscopic Surgery and What Are Its Advantages?
Arthroscopic surgery is a minimally invasive procedure performed through a few small incisions in the shoulder using a small camera (arthroscope) and special surgical instruments. The advantages of this method include less pain, smaller scars, less tissue damage, and a faster recovery process. The surgeon can directly view the inside of the shoulder joint and can also identify and fix other problems while repairing the tear.
When Is the Open Surgery Method Used?
Open surgery is a traditional method where the surgeon makes a larger incision to open the shoulder. This method is generally preferred for very large or complex tears, when bone spurs need to be removed, or when additional procedures like tendon transfer need to be performed. Although open surgery is more invasive, in some cases, it provides the surgeon with better access to the tear and allows for a more secure repair.
What Are the Preparations Before Surgery?
Pre-operative preparations begin with an assessment of the patient’s general health. The doctor may request blood tests, an ECG, and a chest X-ray. All medications the patient is taking are reviewed. The use of blood-thinning medications may be stopped before the operation. It is important for the patient to ask questions about the surgery and mentally prepare for the process. It is also recommended to arrange a support system (family, friends) for the post-operative period.
How Long Does the Surgery Take?
The duration of rotator cuff repair surgery varies depending on the size of the tear, its complexity, and the surgical method used. Generally, this type of surgery takes between one and two hours. However, if the surgeon needs to perform additional procedures during the operation (for example, cleaning a bone spur or repairing another tendon), the duration may be extended. The patient can usually be discharged on the same day.
What Type of Anesthesia Is Used During Surgery?
For rotator cuff repair surgery, either general anesthesia or regional anesthesia (nerve block) is generally preferred. With general anesthesia, the patient sleeps throughout the surgery and feels nothing. Regional anesthesia (nerve block) numbs only the area to be operated on, and the patient can remain awake or be lightly sedated. The anesthesiologist decides on the most suitable method based on the patient’s health and the surgeon’s preferences.
How Big Must a Tear Be to Require Surgery?
Whether a tear requires surgery does not depend solely on its size, but also on the patient’s age, activity level, and the severity of symptoms. Large full-thickness tears usually require surgical intervention. Even small tears, if they severely affect the patient’s quality of life and do not respond to conservative treatments, may lead to a decision for surgery. This decision is made through a joint evaluation by the doctor and the patient.
How Is Post-Surgery Pain Management Handled?
Post-surgery pain management is very important for the patient’s comfort and recovery process. Pain medications are usually prescribed upon hospital discharge. Pain levels may be high in the first few days. Applying ice is an effective method for reducing pain and swelling. Regular use of the medications recommended by your doctor helps to keep the pain under control. If necessary, stronger pain relievers can also be used.
How Long Is the Shoulder Sling Used?
The shoulder sling is of vital importance in the post-operative recovery process to protect the shoulder and support healing. Depending on the type of surgery and the size of the tear, the duration of sling use generally ranges from 4 to 6 weeks. Using the sling as recommended by the doctor during this period ensures that the repaired tendon remains safe and reduces the risk of re-tearing.
When Does Physical Therapy Begin and How Long Does It Last?
The time to start physical therapy depends on the complexity of the surgery and the surgeon’s protocol. It generally begins within the first few weeks after the operation. Physical therapy sessions usually last for 3 to 6 months, but full recovery and regaining function can take up to a year. The initial stage begins with passive movements, followed by a gradual transition to active exercises.
What Are the Post-Surgery Exercises?
The physical therapy program includes specific exercises aimed at progressively regaining the shoulder’s mobility and strength. Initially, passive range-of-motion exercises (where someone else moves the arm) are performed. Later, the program progresses to active range-of-motion exercises where the patient moves their own arm. Finally, exercises to strengthen muscles and increase endurance are added to the program.
What Is the Process of Returning to Normal Life and Work?
The process of returning to normal life and work depends on the nature of the person’s job. Those who work at a desk can usually return to work within a few weeks. However, those who perform more physically demanding jobs may have to wait for a longer period until they regain the full strength and mobility of their shoulder. This process generally ranges from 3 to 6 months.
When Can I Start Driving Again?
The time to start driving depends on regaining full control of the operated shoulder. Generally, the patient can start driving when they have taken off the sling and have regained enough mobility and strength to safely turn the steering wheel. This process can take approximately 6 to 8 weeks after the surgery. However, this period may vary from person to person.
Does Massaging the Shoulder Speed Up the Recovery Process?
Massaging the shoulder during the post-operative recovery process should only be done with the approval of a doctor or physical therapist and at the right time. Massaging too early can damage the repaired tendon. In the later stages of healing, professional massages performed by a physical therapist can be beneficial to soften scar tissue and reduce muscle tension. It is important to avoid self-massage or incorrect massage techniques.
Is There a Risk of a Re-tear After Surgery?
Yes, there is a risk of a re-tear after surgery. This risk depends on the size of the tear, the quality of the tendon, the patient’s age, the surgical technique, and whether the post-operative rehabilitation is performed correctly. This risk is generally slightly higher in large tears or in older patients. Adhering strictly to the physical therapy program and avoiding overstraining the shoulder reduces the risk.
When Is It Possible to Return to Sports Activities?
Returning to sports activities varies depending on the scope of the surgery and the type of sport. Light sports (walking, cycling) can usually be resumed after a few months. For more intense or shoulder-straining sports (tennis, swimming, baseball, weightlifting), full functional recovery must be awaited. This generally can take from 6 months to a year. Your physical therapist and surgeon will help you determine the safest time to return to sports.
What Is the Success Rate of the Surgery?
The success rate of rotator cuff repair surgery is quite high. Success is defined as the reduction of the patient’s pain and the regaining of shoulder function. The success rate for small and medium-sized tears is over 90%. However, the success rate may be slightly lower in very large tears or when the tendon quality is poor. The patient’s commitment to rehabilitation directly affects success.
What Are the Risks and Complications of Surgery?
As with any surgical procedure, there are some risks associated with rotator cuff repair surgery. These risks include infection, nerve damage, bleeding, reactions to anesthesia, and shoulder stiffness (frozen shoulder). A re-tear of the repaired tendon is also a possible, though rare, complication. Your surgeon takes the necessary precautions to minimize these risks and informs the patient.
How Much Does Rotator Cuff Surgery Cost in Turkey?
The cost of rotator cuff surgery in Turkey varies greatly depending on the hospital, the surgeon’s experience, the size of the tear, the surgical method used, and the duration of the operation. In public hospitals, surgeries are covered by the Social Security Institution (SGK), while prices vary in private hospitals. Although it is not possible to give an average price, prices in private hospitals can generally start from a few thousand dollars and increase depending on the surgery.
Does Insurance Cover the Surgery?
Private health insurance companies in Turkey may cover the costs of rotator cuff surgery depending on the policy coverage. Comprehensive insurance policies generally cover the costs of the operation, hospital stay, and post-operative physical therapy. However, insurance companies may have waiting periods or specific conditions. Therefore, it is important to contact your insurance company before the operation to learn the coverage details.
How Can I Find the Best Surgeon?
The most important factors to consider when choosing a surgeon are the surgeon’s experience and expertise in the field. Orthopedic and Traumatology specialists, especially those experienced in shoulder surgery, should be preferred. It may be useful to find out how many rotator cuff surgeries your surgeon has performed before, their success rates, and patient reviews. It is also important that your surgeon communicates well with the patient and answers all of your questions.
How Should Pre- and Post-Surgery Nutrition Be?
Proper nutrition before and after surgery supports the recovery process. Eating a healthy and balanced diet before the operation helps the body prepare for surgery. In the post-operative period, eating foods rich in protein, Vitamin C, and zinc accelerates tendon repair and tissue healing. Drinking plenty of water to ensure hydration is also very important.
Can a Tear Be Treated Without Surgery?
The treatment of a rotator cuff tear without surgery depends on the size and type of the tear. Partial tears or small full-thickness tears can be successfully treated with conservative methods such as physical therapy, exercises, and pain management. However, for large and full-thickness tears or tears that do not respond to conservative treatments, surgical repair is generally recommended as the best and most permanent solution.
