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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 buttonhole-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 joint and help the shoulder joint to move. The tendons can be torn from overuse or injury.

You will likely receive general anesthesia before this surgery. This means you will be asleep and unable to feel pain. Or, you may have regional anesthesia. Your arm and shoulder area will be numbed so that you do not feel any pain. If you receive regional anesthesia, you will also be given medicine to make you very sleepy during the operation.

Three common techniques are used to repair a rotator cuff tear:

  • During open repair, surgical incision is made and a large muscle is moved out the way to do the surgery. Open repair is done for large or more complex tears.
  • During arthroscopy, the arthroscope is inserted through small incision. The scope is connected to a video monitor. This allows the surgeon to view the inside of the shoulder. One to three additional small incisions are made to allow other instruments to be inserted.
  • During mini-open repair, any damaged tissue or bone spurs are removed or repaired using an arthroscope. Then during the open part of the surgery, a 2- to 3-inch incision is made to repair the rotator cuff.
  • To repair the rotator cuff, the tendons are re-attached to the bone.
  • 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 the repairs that were 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 to 12 months.
  • You are active and use your shoulder for sports or work.
  • You have weakness and are unable to do everyday activities.

Surgery is a good choice when:

  • You have a large or a complete rotator cuff tear.
  • A tear was caused by a recent injury.
  • The tendons of the rotator cuff were not already torn from chronic rotator cuff problems.

A partial tear may not require surgery. Instead, rest and exercise are used to heal the shoulder. This approach is often best for persons who do not place a lot of demand on their shoulder. Pain can be expected to improve. Weakness will not improve. The tear will likely become larger over time. You may be limited in the sports or other activities you can do.

Risks

Risks of anesthesia are:

  • Allergic reactions to medications
  • Problems breathing

Risks rotator cuff surgery are:

  • Bleeding
  • Infection
  • Injury to a blood vessel or nerve

Before the Procedure

Tell your health care provider what medicines you are taking. This includes medicines, supplements, or herbs you bought without a prescription.

During the 2 weeks before your surgery:

  • You may be asked to stop taking medicines that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), and other medicines.
  • Ask your health care provider which medicines you should still take on the day of your surgery.
  • If you have diabetes, heart disease, or other medical conditions, your surgeon will ask you to see your doctor who treats you for these conditions.
  • Tell your health care provider if you have been drinking a lot of alcohol, more than 1 or 2 drinks a day.
  • If you smoke, try to stop. Ask your health care provider or nurse for help. Smoking can slow wound and bone healing.
  • Tell your surgeon about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery.

On the day of surgery:

  • You will likely be asked not to drink or eat anything for 6 to 12 hours before the procedure.
  • Take the medicines your surgeon told you to take with a small sip of water.
  • Your surgeon or nurse will tell you when to arrive at the hospital. Be sure to arrive on time.

After the Procedure

Follow any discharge and self-care  instructions you are given.

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.

Recovery can take 3 to 6 months, depending on the size of the tear and other factors. You may have to wear a sling for 4 to 6 weeks after surgery. Pain is usually managed with medicines.

Physical therapy can help you regain the motion and strength of your shoulder. The length of therapy will depend on the repair that was done.

Outlook (Prognosis)

Surgery to repair a torn rotator cuff is usually successful in 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 depends on the surgery that was done. Expect 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 torn or weak before the injury.
  • Larger tears
  • After-surgery exercise and instructions are not followed.
  • Older patients (over age 65)
  • Smoking

References

Gartsman GM. Shoulder Arthroscopy. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2008.

Miller RH III, Asar FM, Throckmorton TW. Shoulder and elbow injuries. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics. Philadelphia, PA: Elsevier Mosby; 2012:chap 46.

Warren RF, ed. Shoulder arthroscopy. In: Rockwood CA, Matsen FA III, Wirth MA, et al., eds. The Shoulder. 4th ed. Philadelphia, PA: Elsevier Saunders; 2009:chap 20.

Updated: 4/16/2013

C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial Team.


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