Dr. Skendzel Explains Rotator Cuff Surgery
Learn about how Summit personalizes rotator cuff surgery to your needs and goals.
The rotator cuff is a group of tendons that stabilize our shoulder joint. Traumatic injuries—like falls during slick Minnesota winters or the joint degeneration that accompanies the aging process—can cause these tendons to tear. Persistent pain and shoulder weakness are the most common warnings of a torn rotator cuff. But an injury doesn’t necessarily mean that rotator cuff surgery is in the cards. Shoulder specialist Dr. Jack Skendzel discusses the surgical and nonsurgical treatments used to treat rotator cuff injuries.
Evaluating shoulder pain
“The shoulder is a complex joint, so the medical evaluation and physical exam are really important,” he explains. “If you come in with shoulder pain and weakness, I’ll do a physical examination to check motion and strength, and I’ll order X-rays to look for fractures or arthritis. Often, an MRI is also done to evaluate soft tissue details in the tendons and muscle and confirm a tear.”
Nonsurgical treatment options for rotator cuff surgery
Dr. Skendzel explains that treatment for a torn rotator cuff usually begins with nonsurgical options, especially for patients who are averse to surgery or who are not good surgical candidates. There are two nonsurgical treatments for rotator cuff injuries.
- Physical therapy. Some patients work with a physical therapist to strengthen partial tears and to strengthen the muscles around the torn tendon.
- Cortisone shots. “A cortisone injection can alleviate pain and swelling,” Dr. Skendzel explains. “These injections won’t heal the tear, but they do relieve pain and can make physical therapy more comfortable.”
When to consider rotator cuff surgery
“Our job is to help you get back to an active lifestyle,” says Dr. Skendzel. “Your preferences and goals are an important part of creating a treatment plan. If we’ve tried nonsurgical treatments and you’re still having pain or weakness that is significantly interfering with your ability to play sports or to play with your grandchildren or fish at the cabin or work comfortably, we’ll consider rotator cuff surgery to fix your tear.”
There are three types of rotator cuff surgery:
- Open surgery. This traditional surgical technique involves a long surgical incision over the shoulder and detachment of the deltoid muscle to access the torn tendon.
- Mini-open surgery. A mini-open repair involves a 3 to 5 cm incision and use of arthroscopic instruments to repair the tear without detaching the deltoid muscle. “In some cases, using a mini-open surgery facilitates repair,” explains Dr. Skendzel. “These include cases involving very large tears or a tear in the subscapularis or front tendon.”
- Arthroscopic surgery. Arthroscopic procedures use the smallest incisions. Guided by an arthroscope inserted in the shoulder joint, the surgeon uses a video monitor and tiny surgical instruments to repair the tear.
“At Summit, we offer all three types of rotator cuff surgery,” says Dr. Skendzel. “Research tells us that all three surgical approaches result in good outcomes. That said, I do 95 percent of my rotator cuff repairs arthroscopically.”
The advantages of arthroscopic rotator cuff repair
“I was trained in arthroscopic surgery,” says Dr. Skendzel. “For me, the advantage of arthroscopy is working with the tiny camera and the video monitor. It enables me to better visualize the tendons, work efficiently, and minimize damage to the surrounding soft tissue. Often times, arthroscopy also enables us to address other shoulder issues during a surgical rotator cuff repair. For example, I can clean out bursitis, which is inflammatory tissue, and plane out any bone spurs in the joint. In addition, I always address the biceps tendon, which is prone to tendinitis and fraying following a rotator cuff repair. To prevent this, I cut, move, and reattach the biceps tendon to prevent pain down the road.”
Dr. Skendzel values the comprehensive surgical treatment he can provide arthroscopically. “There are things I can do with an arthroscope that I can’t do with an open incision,” he explains. “There’s also less damage to the surrounding soft tissues. These advantages make arthroscopy the standard of care in 2019.”
Advanced pain protocols comfortably minimize opioid use
“Rotator cuff surgery has a reputation for being painful,” notes Dr. Skendzel. “Combine that with today’s concerns about opioid overuse, and it’s understandable that patients might feel apprehensive about surgery. That’s why Summit developed comprehensive multimodal pain protocols for our shoulder surgeries. These protocols are designed to keep patients comfortable and minimize the use of opioid medications. Our skilled surgical and anesthesiology teams use regional anesthesia blocks, a nerve block, and additional long-lasting numbing medication in the shoulder. As a result, patients are very satisfied with their postsurgical experience. Also, they report needing significantly less pain medication than they were anticipating. It’s very gratifying to provide surgical expertise and a mindful approach to pain management that delivers such a great experience for our patients.”
What to expect during recovery and rehabilitation
“Perhaps the biggest downside to rotator cuff surgery is that you are in a sling for six weeks following surgery,” says Dr. Skendzel. “It’s inconvenient, but your shoulder needs that time to allow the tendon and bone to knit together. Joint stiffness is always a concern. That’s why physical therapy begins four weeks after surgery. At first, the therapist will move your arm to safely prevent stiffness and activate the muscle. Gradually, as the tissues heal, you’ll move to active exercise.
“I can’t emphasize enough how important therapy is to overall rehabilitation,” Dr. Skendzel continues. “In fact, this is one of the reasons Summit offers the services of performance specialists as well as physical therapists. When patients want to continue strengthening beyond the physical therapy covered by insurance, they can transition seamlessly to a more cost-effective performance specialist. Our therapists and specialists work side by side, so you benefit from continuity of personalized care. When you want to continue to strengthen your shoulder following physical therapy, working with our performance specialists makes it easy for you to safely continue rehabilitation until you reach your functional objective.”
On average, patients can expect a rehabilitation period of four to six months before a full return to a higher level of function. “This rehabilitation period could be longer, depending on the patient,” notes Dr. Skendzel. “Younger patients tend to recover more quickly. But each patient’s journey is unique, and recovery is not about numbers.”
Personalized treatment plans support your goals
When Dr. Skendzel cares for patients with a rotator cuff injury, the treatment plan always reflects individual preferences and goals. “Sometimes, patients will tell me that it’s just not the right time for surgery,” he says. “And that’s fine. My treatment approach is informed by your circumstances, your history, your lifestyle, and your personal objectives. All of us at Summit are here to provide the expertise and resources to create an individualized treatment plan that supports your goals.”
Summit Orthopedics offers comprehensive sports medicine expertise
From Olympians to pro athletes to kids in youth sports and those who just want to be more active—Summit Orthopedics delivers expert care by fellowship-trained sports medicine physicians. If you are recently injured or concerned about ongoing pain, Summit Orthopedics sports medicine specialists have the expertise to evaluate your discomfort and develop a plan to quickly and safely help you get back to being active.
Summit has convenient locations across the Minneapolis-St. Paul metro area, serving Minnesota and western Wisconsin. We have state-of-the-art centers for comprehensive orthopedic care in Eagan, MN, Plymouth, MN, Vadnais Heights, MN, and Woodbury, MN, as well as additional community clinics throughout the metro and southern Minnesota.
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