Rotator Cuff Tear: Must one undergo surgery for partial tears? Professor Lee Hee-dong explains the criteria for deciding on surgery

Rotator cuff tear, one of the major causes of shoulder pain, has the decision for surgery determined by the symptoms and the extent of the tear, and systematic rehabilitation for about 6 months is essential after surgery. Professor Lee Hee-dong of the Department of Orthopedic Surgery at Kangbuk Samsung Hospital explained the definition of rotator cuff tears, the difference from frozen shoulder, and the criteria for surgical treatment in a recently released video.

Differences between Rotator Cuff Tear and Frozen Shoulder and Criteria for Deciding on Surgery

The rotator cuff refers to the part where muscles turn into tendons to attach to the bone, and a rotator cuff tear refers to the state where these tendons detach from the bone. The official name for the condition commonly called 'frozen shoulder' is 'adhesive capsulitis,' which refers to a phenomenon where the joint capsule tissue surrounding the shoulder becomes stuck due to inflammation, causing the shoulder to stiffen. This is a different disease from a rotator cuff tear where the tendon detaches.

The occurrence of a rotator cuff tear does not mean all patients must undergo surgery. In cases of partial tears, patients can return to daily life by improving pain through conservative methods such as medication, physical therapy, and injection therapy. However, if a partial tear progresses to a full-thickness tear over time, the muscle may fail to function properly and fatty degeneration may occur, making surgery impossible. Professor Lee Hee-dong stated that when deciding on surgery, the patient's age, symptoms, shoulder function, and the extent of the tear are comprehensively judged. For younger patients with high activity levels, active surgery tends to be recommended as there is a high possibility of the tear progressing, while for elderly patients or those with low activity levels, conservative treatment is recommended.

Purpose of Using Collagen Patches and the Post-Surgical Rehabilitation Process

In some cases, collagen patches are used during surgery to fix the tendon to the bone. While not mandatory, they are used to help reinforce the tendon and maintain its position for patients whose tendon condition is very poor and frayed, or those with a large tear area who have a high risk of re-tearing. Although there are no literature reports yet that the use of collagen shortens the recovery period, it may help in reducing the probability of re-rupture.

After surgery, a process of about 6 months is required for the tendon to fully attach to the bone. Professor Lee Hee-dong emphasized that patients should wear a brace and have a period of stability for about one month after surgery. After that, for 1 to 2 months, stretching is performed to expand the range of motion of the shoulder, and once the range of motion is recovered after about 3 months, they proceed through isometric exercises and gradually begin strength training using light dumbbells or bands. Eating should be possible within one month after surgery, and driving should be possible after about two months, but it is important to rest from intense exercises such as swimming, golf, or tennis for about 6 months.

Symptoms and Causes Requiring a Hospital Visit for Shoulder Pain

Major signals that one should visit a hospital when experiencing shoulder pain include a feeling of decreased muscle strength or 'night pain,' where the pain worsens at night. If the pain is fine during the day but becomes severe enough to prevent sleep when lying down to sleep, a hospital visit is necessary. On the other hand, symptoms where the shoulder simply stiffens and movement is limited can be monitored a bit longer.

The main cause of rotator cuff tears is degenerative disease due to aging. It occurs more naturally as people age rather than being caused by accidents or impacts. Meanwhile, he explained that the symptom of the shoulder stiffening occurs due to inflammation of the joint capsule, which can appear in women with a history of diabetes, thyroid disease, or breast cancer surgery.