Rotator cuff repair

Surgery Overview

Surgery may be used to treat a rotator cuff disorder if the injury is very severe or if nonsurgical treatment has failed to improve shoulder strength and movement sufficiently.

The rotator cuff is a group of four tendons and the related muscles that stabilize the shoulder joint and allow you to raise and rotate your arm. The shoulder is a ball-and-socket joint with three main bones: the upper arm bone (humerus), the collarbone (clavicle), and the shoulder blade (scapula). These bones are held together by muscles, tendons, ligaments, and the joint capsule. The rotator cuff helps keep the ball of the arm bone seated into the socket of the shoulder blade.

Surgery to repair a torn rotator cuff tendon usually involves:

• Removing loose fragments of tendon, bursa, and other debris from the space in the shoulder where the rotator cuff moves (debridement).
• Making more room for the rotator cuff tendon so it is not pinched or irritated. If necessary, this includes shaving bone or removing bone spurs from the point of the shoulder blade (subacromial smoothing).
• Sewing the torn edges of the supraspinatus tendon together and to the top of the upper arm bone (humerus).

In open shoulder surgery, a surgeon makes an incision [2 in. (5 cm) to 3 in. (7.6 cm)] in the shoulder to open it and view the shoulder directly while repairing it. A smaller incision can be done with a mini-open procedure that allows the surgeon to reach the affected tendon by splitting the deltoid muscle. This method may reduce your chances of problems from a deltoid injury.

Open-shoulder surgery often requires a short stay in the hospital.

General anesthesia or a nerve block may be used for these types of surgical repair.

Rotator cuff tears can sometimes be repaired with arthroscopic surgery.

What To Expect After Surgery

Discomfort after surgery may decrease with taking pain medications prescribed by your health professional.

The arm will be protected in a sling for a defined period of time, especially when at risk of additional injury.

Physical therapy after surgery is crucial to a successful recovery. A rehabilitation program may include the following:

• As soon as you awake from anesthesia, you may start doing exercises that flex and extend the elbow, wrist, and hand.
• The day after surgery, if your health professional allows, passive exercises that move your arm may be done 4 to 5 times daily (a machine or physical therapist helps the joint through its range of motion).
• Active exercise (you move your arm yourself) and stretches, with the assistance of a physical therapist, may start 6 to 8 weeks after surgery. This depends on how bad your tear was and how complex the surgical repair was.
• Strengthening exercises, beginning with light weights and progressing to heavier weights, can start a few months after surgery.

Why It Is Done

Surgery to repair a rotator cuff is done when:

• A rotator cuff tear is caused by a sudden injury. In these cases, it's best to do surgery within a few weeks of the injury.¹
• A complete rotator cuff tear causes severe shoulder weakness.
• The rotator cuff has failed to improve with 3 to 6 months of conservative nonsurgical treatment alone (such as physical therapy).
• You need full shoulder strength and function for your job or activities, or you are young.
• You are in good enough physical condition to recover from surgery and will commit to completing a program of physical rehabilitation.

How Well It Works

Rotator cuff repair surgery for a tear from a sudden injury works best if it is done within a few weeks of the injury. But repairs of very large tears are not always successful.¹

Rotator cuff surgery to repair frayed or thinned tendon tissue is less likely to work than surgery to repair an injury to a healthy tendon.²

Risks

In addition to the risks of surgery in general, such as blood loss or problems related to anesthesia, complications of rotator cuff surgery may include:

• Infection of the incision or of the shoulder joint.
• Pain or stiffness that won't go away.
• Damage to the deltoid tendon or muscle (if the deltoid is detached, additional surgery may be necessary to repair it).
• The need for repeated surgery because tendons do not heal properly or tear again.
• Nerve damage (uncommon).
• Reflex sympathetic dystrophy (rare).

What To Think About

Very large tears [greater than 2 in. (5 cm) or involving more than one rotator cuff tendon] often cannot be repaired. Grafting and patching procedures are possible, but they are not much better at restoring strength than debridement and smoothing, which are less risky and require less rehabilitation.

Less active people (usually those older than 60) with confirmed rotator cuff tears that do not cause pain, significant weakness, or sleep problems can safely go without surgery unless symptoms get worse.

• Some people who do not have surgery to repair severe rotator cuff tears develop cuff tear arthropathy, a condition of progressive arthritis, pain, and significant loss of strength, flexibility, and function.
• In some cases, arthroscopic debridement and smoothing adequately relieves pain and restores enough function to allow daily activities, and open surgery is not necessary.

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Author:	Shannon Erstad, MBA/MPH	Last Updated: February 8, 2008
Medical Review:	William M. Green, MD - Emergency Medicine Patrick J. McMahon, MD - Orthopedics
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