Rotator cuff repair refers to shoulder surgery to treat a torn rotator cuff tendon. The rotator cuff is a group of four tendons and the related muscles, which stabilize the shoulder joint and allow you to raise and rotate your arm. The rotator cuff helps keep the ball of the arm bone (humerus) seated into the socket of the shoulder blade.
In the process of rotator cuff repair, the orthopedic surgeon will remove loose fragments of tendon and other debris from the space in the shoulder where the rotator cuff moves (debridement). Then, more room is made for the rotator cuff tendon (so it is not pinched or irritated) by shaving bone or removing bone spurs (subacromial smoothing). Finally, the torn edges of the tendon are sewed together, and then sewed to the top of the upper arm bone. This process requires a 2-3 inch incision to open and view the shoulder directly.
In another procedure, smaller incisions are made by splitting the deltoid muscle (the muscle forming the rounded contour of the shoulder), which may reduce risk of complications from a future deltoid injury. Both surgeries require both regional and general anesthesia and necessitate a short hospital stay.
Who is a candidate?
Candidates have painful shoulder conditions that do not respond to nonsurgical treatment such as rest, physical therapy, and medications or injections that reduce inflammation. Typically, injury, overuse and age-related wear and tear are responsible for most shoulder problems.
Who is not a candidate?
Candidates who have not yet exhausted nonsurgical treatment options or who are suffering from an active infection in the shoulder are generally not good candidates for rotator cuff repair. For less severe shoulder conditions, an arthroscopic surgery may be a better fit in order to treat the condition with less recovery time.
Preparation
Like other surgeries, rotator cuff repair requires a complete physical examination with your primary care provider before surgery. You should inform your orthopedic surgeon of any medications or supplements you take, and comply with certain general surgery procedures such as preoperative blood testing and possible cessation of smoking or use of pain relievers and anti-inflammatory drugs one week prior. You will likely be asked to stop eating or drinking the night before the surgery.
Recovery
In the case of regional anesthesia (numbing the area between your neck and the end of your torso), you may not be able to move your shoulder and hand, your eyelid may droop, and you may feel numbness in your shoulder and hand for 12 to 20 hours after the surgery. This is normal. After this anesthesia has worn off and you feel some pain, you will be able to take medication for pain relief. In the first few days after surgery, keep your shoulder in the cuff or brace provided and apply ice to relieve swelling and prevent further inflammation. Ensure your incisions are kept clean and dry, and follow your surgeon’s instructions about bathing, changing the dressing, and follow-up visits.
You can expect to stop wearing a sling after 4 to 6 weeks. Repair of a rotator cuff tendon usually takes 4 to 6 months to heal well enough for a return to full activity. A formal physical therapy program, or a regimen of exercises to strengthen your shoulder, is necessary and make take several months to a year to ensure a complete recovery.
Risks
As with any surgery, there are risks of complications related to infection or adverse reactions to anesthesia. Other known complications include nerves and blood vessel injuries, blood clots, and the need for additional revision surgery if the tendons do not heal properly or tear again. In the case of more invasive shoulder surgery, there may be damage to the deltoid tendon or muscle, which may require additional surgery to repair. Pain and stiffness are expected and may persist in some form even with physical therapy.
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