Rotator cuff repair

Definition 

The rotator cuff is a group of muscles and tendons that form a cuff over the shoulder. These muscles and tendons hold the arm in its “ball and socket” joint and help the shoulder to rotate. 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.

Rotator cuff repair is a type of surgery to fix a torn tendon in the shoulder. The procedure can be performed with a traditonally large (“open”) incision or with Shoulder arthroscopy, which uses small button-hole sized incisions.

Description  

Commonly, your shoulder is first evaluated with an arthroscope to look at the tear and determine if it can be fixed. An arthroscope is a small camera 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 evaluate 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 evaluate the area above the rotator cuff, clean out 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 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 plastic, and do not need to be removed.

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 was found and what was done.

Indications 

Rotator cuff repair may be recommended for shoulder problems such as:

     
  • Pain, especially using the arm overhead  
  • Weakness  
  • A bone spur or inflammation around the rotator cuff

Risks 

The risks for any anesthesia are:

The risks for any surgery are:

     
  • Bleeding  
  • Infection  
  • Nerve damage

Additional risks include:

     
  • Stiffness of the shoulder  
  • Failure of the surgery to relieve symptoms  
  • Failure of the repair to heal  
  • Weakness of the shoulder

Expectations after surgery 

Surgery to repair a torn rotator cuff is usually very successful at relieving pain in the shoulder. The procedure is less predictable at returning strength to the shoulder. Rotator cuff repair can require a long recovery period, especially if the tear was large.

In many cases, arthroscopy reduces the need to surgically open the shoulder joint. This can resulted in less pain and stiffness. In cases of repair, one should remember that the body still needs to heal after arthroscopic surgery, just as if the surgery was done open. Therefore, the overall recovery time will still be lengthy.

Convalescence 

The recovery can take anywhere from three to six months, depending on the size of the tear and other factors. Most patients wear a sling after surgery for the first week. This may be extended up to six weeks. Pain is usually managed with medications.

The ability for you to return to work or play sports will depend on the surgery that was performed, but will usually take several months.

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

Johns Hopkins patient information

Last revised: December 7, 2012
by Sharon M. Smith, M.D.

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