The rotator cuff is a group of four muscles that surround the shoulder and attach via tendons to the head of the upper arm bone, holding the shoulder joint in place and enabling the movement and rotation of the arms and shoulders. It may be torn acutely due to a sudden accident or fall, or if it is injured, what starts out as inflammation can become small tears that eventually progress to large ones if not treated.

Treatment strategy for small, partial tears and tendinopathy (wear and tear) include physical therapy, injections, and/or such as PRP, platelet rich plasma. However, for patients unable to regain range of motion and strength through non-operative measures, or where there is a full thickness tear or complete rupture where the tendon tears off the bone, surgery may be needed. Traditionally, surgeries for these injuries required long and painful recovery times, with full range of motion never returning. Some irreparable tears were not able to be treated at all.

Mayo Clinic has been at the forefront of surgical innovations to remedy all that. Working with elite and professional athletes such as the Minnesota Twins has taught our sports medicine experts how to deal with significant injuries, optimize performance, and get athletes not only back to an extremely high level of play, but back out there sooner. “The relationship (with the Twins) allows us to be on the cutting edge of some of the newest treatments and technology that historically have not been available to the general public,” says Christopher Camp, M.D., orthopedic surgeon, Mayo Clinic Orthopedics and Sports Medicine, Medical Director and team physician, Minnesota Twins. At Mayo, all patients can benefit from these new technologies and techniques; in the world of rotator cuffs, one such area of innovation, Jacob Sellon, M.D., sports medicine physician, co-director, Mayo Clinic Orthopedics and Sports Medicine explains, “is in the realm of ultrasound guided surgical procedures.”

For rotator cuff injuries, what used to be done through an open surgery approach, which is traditionally what one thinks of as surgery when skin and tissue are cut, can now be done through a minimally invasive, or arthroscopic approach, in which surgeons insert a tiny camera (arthroscope) and tools through small incisions. Arthroscopy is very safe, complications are uncommon, and recovery time is faster.

The rotator cuff is deep inside the body and being able to use these minimally invasive techniques allows surgeons to get there without causing much, or any, damage to the surrounding structure. “Using small incisions and smaller instruments is tremendously helpful for patients and can really have a positive impact on their outcome” for many reasons, says Dr. Camp. It is important to note that for all surgeries, physical therapy is crucial in recovery and restoration of strength and range of motion, and at our Rotator Cuff Specialty Clinic, experts work with you to create and implement that plan.

Benefits of minimally invasive rotator cuff surgeries include:

• Faster recovery and healing time (how long is recovery time? Ask SME)
• Less pain
• Fewer complications
• Outpatient procedure
• Smaller scars
• Small incisions

The different types of minimally invasive rotator cuff surgeries performed at Mayo include:

Debridement

This is when loose or damaged tissue is removed, and any spurs that may be impinging on the cuff causing the tendonitis or tear cleaned out.

Tendon repair

Sometimes, one or more tendons become detached from the bone. We can now do tendon repair, where the tendon is reattached to the bone using small anchors, sutures, and new technologies, through minimally invasive surgery.

Irreparable tears

“I think the area where we’ve seen the greatest advance in the last five years are for those tears that historically would be considered irreparable,” says Dr. Camp. For patients who have these irreparable rotator cuff tears, which means the tears are so large or retracted, or the muscle atrophied so that it is no longer able to be fixed, we now offer hope. We repair the tendon as best we can, then use a graft from the patient’s own body, or a donor, to fill in the remaining defect. We may also insert spacers into the shoulder.

Outstanding Results

• Overall, the results from these minimally invasive surgeries have an 80 to 90% success rate for most tears, varying based on the type of tear.
• These surgeries have proven to be extremely predictable in their ability to improve pain and range of motion, with good results at improving strength. Strength improvement is more complex to predict because it requires not only the surgery, but also effective physical therapy afterwards.
• For the surgeries that require grafts, recovery takes about six months for the graft to become incorporated (is that correct recovery time? Confirm with SME) and our data shows that even at five years out, these results hold up and can reliably relieve pain and improve range of motion.

Mayo Clinic’s research and development in the realm of surgery for rotator cuff injuries has improved countless lives, which is why we do what we do here. “The most rewarding part of my job,” Dr. Camp says, “is interacting with the patient who now is three or six months past surgery, and tells me, ‘This is the best my shoulder joint has felt in 10 years. I never thought I’d be able to lift my arm up over my head or have the amount of strength that I do. Thank you for giving me my life and function back.’”

Whether you’re a professional or recreational athlete, a weekend warrior, or have a job that places high demands on your shoulders, our goal is for you to continue doing what you enjoy, as long as possible – and to get you back to doing it sooner. That is why we have the dedicated Rotator Cuff Specialty Clinic, with a team that lays out the right diagnosis and treatment plan, and where you have access to the newest surgical techniques, performed by physicians who played a role in developing them. Find out more by contacting the clinic in Minneapolis, MN or Rochester, MN today.

For more information, or to make an appointment, please visit sportsmedicine.mayoclinic.org.