Recurrent Rotator Cuff Tears

The rotator cuff consists of muscles and tendons that connect the arm to the shoulder blade. Tears in this network of muscles and tendons may occur due to overuse of the shoulder, injury, lack of blood supply, bone spurs, and normal wear and tear of the joint, causing pain and disability. A torn rotator cuff can usually be repaired by suturing it to its original position. However, tears can recur even after surgery.

Recurrent rotator cuff tears especially occur with large tears. Problems in the surgical technique or during the healing process may also contribute to its recurrence. These may include pulling out of the sutures placed during surgery to hold the soft tissue together due to high tension, minor contractions that occur in the muscle even during post-surgical immobilization, patient non-compliance to post-surgery instructions, and changes in the properties of the tendon depending on the duration of time from when it was torn. Apart from these, advanced age, general health, presence of other diseases and medications may also play a part in re-tears.

Persistent pain, loss of function and shoulder movement several months following surgical repair is usually an indication of a recurrent rotator cuff tear. Sometimes, recurrent tears are asymptomatic and show up during your periodic follow-up visits to your doctor. At these visits, your doctor will review your history and physically examine the shoulder for motion, function and strength. It is very important to determine the exact cause of the failed surgical repair. Ultrasound imaging studies may be ordered to evaluate the integrity of the rotator cuff tendons as they heal and placement of the sutures.

Your doctor will first suggest conservative treatment with rest, activity modification, using a sling, physical therapy to improve the strength and stability of the joint, and steroid injections to relieve pain and swelling.

If symptoms do not resolve, repeat surgery will have to be considered. Depending on the type of tear, surgical treatment may include removing frayed tendon ends and re-suturing the tendon if it is healthy. A damaged biceps tendon, which helps in the movement of the elbow, may also be repaired. A tendon transfer may have to be done if the tendon has extensive tears. If the quality of the bone is not adequate, joint replacement (hemiarthroplasty or reverse shoulder arthroplasty) using metal and plastic prostheses may be considered.

The postoperative phase is critical with surgical treatment of recurrent rotator cuff tears. A slow and steady rehabilitation program under the guidance of a physical therapist giving the repaired tendons sufficient time to heal will yield a better outcome compared to a more aggressive physical therapy program.