Rotator Cuff Repair
While doctors often first prescribe conservative treatments for a rotator cuff tear, particularly if the tear is a minor one, in many cases a surgical procedure will be necessary.
How is the rotator cuff repaired?
Arthroscopy is the typical surgical method used to correct a torn rotator cuff. During the procedure, a scope (arthroscope) is attached to a small camera to magnify the area for the surgeon. Tiny surgical instruments are inserted through the arthroscope to help repair or remove damaged tissue, as well as to reattach damaged tendons.
In addition, damaged fragments of tendons or bursae in the joint are removed and frayed pieces or edges of the torn tendon are repaired. The surgeon reattaches the damaged tendon to the bone with sutures or anchors. The surgery is commonly performed under local anesthesia in the form of a regional nerve block. Sedation is also administered to keep the patient relaxed.
Although most surgical procedures to repair the rotator cuff are performed arthroscopically, if extensive damage is present open shoulder surgery is performed instead. Open shoulder repair involves a larger incision. This method is used to remove some types of bone spurs or if the tendon is requires reconstruction or repair with a tendon transfer. In some cases, mini-open repairs, which involve a combination of arthroscopic and open shoulder techniques, can also be used.
Shoulder replacement is another surgical method that is sometimes recommended to correct a rotator cuff tear. This method is used for severe tears that cannot be corrected in any other way. General anesthesia is used for replacement surgery and the components of the rotator cuff are replaced with artificial implants.
What can be expected after rotator cuff surgery?
Since anesthesia is administered for this procedure and drowsiness will occur, patients have to arrange for someone to accompany them to and from your surgery. Pain and discomfort are to be expected after the procedure and can be controlled with either prescribed or over-the-counter pain medication, such as Tylenol.
Swelling in the area is also expected and can be alleviated with ice packs. Most surgical procedures performed to repair a rotator cuff are performed in an outpatient surgical center. Overnight stays in hospitals are usually only necessary when a more invasive procedure, such as shoulder replacement surgery, is performed.
What is recovery from rotator cuff surgery like?
After surgery, patients are instructed to wear a sling or immobilizer for 4 to 6 weeks while the joint heals. It is important that patients begin gentle, passive exercises under the direction of a physical therapist directly after surgery to prevent stiffness and promote healing.
Most individuals will be prescribed a physical therapy treatment plan after surgery to help restore strength and mobility to their shoulders, typically for 4 to 6 months. The duration of physical therapy will depend on the type of surgery used to correct your tear and on the speed at which you heal. Athletes who are in excellent condition may be able to resume activity sooner.
Restrictions of certain daily activities may be required for a defined duration after surgery. These restrictions will vary depending on the severity of the injury and the type of surgical procedure performed. The surgeon will provide instructions regarding when the patient can stop using the sling and when it is safe to resume normal activity.
Are there any risks associated with rotator cuff surgery?
Rotator cuff surgery is a routine and safe procedure, but all surgical interventions carry some risks, including:
- Adverse reaction to anesthesia
- Postsurgical infection
- Excessive bleeding
- Long-lasting stiffness of the shoulder joint
- Damage to surrounding nerves, blood vessels, tendons or muscles
- Re-tearing of the repaired tendon
It is important to discuss the risks with your surgeon prior to the procedure and determine if rotator cuff surgery is right for you. Most physicians recommend surgery within weeks of the injury to ensure the best outcome.