Rotator cuff repair
Rotator cuff repair is a type of surgery to repair a torn tendon in the shoulder. The procedure can be done with a large ("open") incision or with shoulder arthroscopy, which uses small button-hole sized incisions.
The rotator cuff is a group of muscles and tendons that form a cuff over the shoulder joint. These muscles and tendons hold the arm in its "ball and socket" joint and help the shoulder to rotate and move. The role of the tendons is to hold the powerful shoulder muscles to the shoulder and arm bones. The tendons can be torn from overuse or injury.
Your surgeon will first check your shoulder with a small camera (arthroscope) to look at the tear and determine if it can be fixed. The arthroscope is inserted into the shoulder through a small poke-hole. The camera is connected to a video monitor. The surgeon looks around the entire joint to check the cartilage, tendons, and ligaments of your shoulder.
After evaluating the shoulder joint, the surgeon places the camera in the space above the rotator cuff tendons, called the subacromial space. The surgeon can check the area above the rotator cuff, clean out the inflamed or damaged tissue, and remove a bone spur (subacromial spur).
If a tear is going to be fixed, the surgeon may perform the surgery with a larger, open incision. Other surgeons can use the arthroscope and 1 - 3 additional small poke-holes or smaller incisions to perform the surgery. The additional small incisions allow the surgeon to insert other instruments to repair damaged tissue.
The goal is to attach the tendon back to the bone where it tore off. The tendon is attached with sutures. Small rivets (called suture anchors) are often used to help attach the tendon to the bone. The suture anchors can be made of metal or material that dissolves over time, and do not need to be removed. Sutures are attached to the anchors, which tie the tendon back to the bone.
At the end of the surgery, the incisions are closed, and a dressing is applied. If arthroscopy was performed, most surgeons take pictures of the procedure from the video monitor to show you what they found and repairs they made.
Why the Procedure Is Performed
Reasons rotator cuff repair may be done include:
- You have shoulder pain when you rest or at night, and it has not improved with exercises over 6 - 12 months.
- You have a large or complete rotator cuff tear.
- You are active and use your shoulder for sports or work.
- You have a lot of weakness and are unable to do everyday activities.
Surgery is a good choice for a person whose tear was caused by a recent injury. It is also a good choice when the tendons of the rotator cuff were not already frayed from chronic rotator cuff problems.
Some patients with a partial tear may choose not to have surgery, using rest and exercise instead. The best candidates for this approach are those who have only a partial tear and do not place a lot of demand on their shoulder.
- Shoulder pain will improve with this approach.
- However, any weakness will not improve, the tear will become larger over time, and you may be limited in the sports or other act ivies you can do.
The risks for any anesthesia are:
- Allergic reactions to medications
- Problems breathing
The risks for any surgery are:
- Nerve damage
After the Procedure
Recovery can take anywhere from 3 - 6 months, depending on the size of the tear and other factors. You may have to wear a sling for 4 - 6 weeks after surgery. Pain is usually managed with medications.
You will be wearing a sling when you leave the hospital. Some patients also wear a shoulder immobilizer. This keeps your shoulder from moving. How long you wear the sling or immobilizer will depend on the type of surgery you had.
Physical therapy may help you regain the motion and strength of your shoulder. The length of therapy will depend on the repair that was performed.
Surgery to repair a torn rotator cuff is usually very successful at relieving pain in the shoulder. The procedure may not always return strength to the shoulder. Rotator cuff repair can require a long recovery period, especially if the tear was large.
When you can return to work or play sports will depend on the surgery that was performed, but it will usually take several months to resume your regular activities.
Some rotator cuff tears may not fully heal. Stiffness, weakness, and chronic pain may still be present.
These poorer results are more likely when the following are present:
- The rotator cuff was already frayed or weak before the injury.
- Larger tears
- After-surgery exercise and instructions are not followed.
- Older patients (over age 65)
Elkousy HA, Edwards TB. Shoulder: Development of skills for shoulder surgery. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez’s Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 17, section Q.
Miller RH II, Dlabach JA. Shoulder and elbow injuries. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 44.
Seida JC, LeBlanc C, Schouten JR, Mousavi SS, Hartling L, Vandermeer B, Tjosvold L, Sheps DM. Systematic review: nonoperative and operative treatments for rotator cuff tears. Ann Intern Med. 2010 Aug 17;153(4):246-55.
Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Dept of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
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