Surgery
Most
rotator cuff disorders are treated without surgery.
But surgery may be considered if the injury is very severe. Surgery also may be
recommended if the shoulder does not respond well after 3 to 6 months of
nonsurgical treatment (rest, ice or heat, use of
nonsteroidal anti-inflammatory drugs, and
physical therapy).1
Should I have rotator cuff
surgery?
Surgery for rotator cuff disorders is done to:
- Repair tendon tears and smooth the underside of
the upper point of the shoulder blade (acromion
) to make more room for the
tendon and bursa. - Restore strength and use of the shoulder.
Surgery may be a good first choice for shoulder weakness caused by
complete tears, especially when the rotator cuff is otherwise healthy (little
or no degeneration). Surgery may be considered if you have severe pain and loss
of shoulder function that has not responded to appropriate nonsurgical
treatment.1 This lack of improvement may indicate that
you have partial rotator cuff tears, complete tears, or subacromial roughness.
Surgery for these problems focuses on creating a smooth passage for the tendon
and bursa beneath the acromion.
You may regain more of your shoulder strength and movement after an
acute tear if it is repaired soon after the injury. If surgery is delayed,
repair of a large tear may not be as successful, but damaged tissues can still
be removed and pressure on the tendon and bursa reduced. This usually relieves
pain and restores enough strength for you to do routine, nonstrenuous
activities.
Rehabilitation after surgery (home treatment and physical therapy)
is important to the success of surgery. People who are not willing or able to
commit themselves to the rigors of physical rehab may not do as well after
surgery.
Surgery Choices
Shoulder surgery for rotator cuff disorders usually involves one
or more of the following procedures:
- Subacromial
smoothing
- Rotator cuff repair
These procedures may be done
arthroscopically, by traditional open surgery, or by a
combination of the two approaches.
What To Think About
Both arthroscopic surgery and open surgery can be effective.
Your surgeon may be more comfortable with one of the methods.
- Open surgery is the traditional type of
surgery for rotator cuff disorders.
- Arthroscopic
debridement and smoothing to repair the rotator cuff
is becoming more common.
- A combination of open surgery and
arthroscopy may allow your doctor to split rather than cut the shoulder muscle
(deltoid) during open surgery, so you may have a less difficult recovery.
The success of surgery for rotator cuff tears depends on many
things, such as:
- The amount of degeneration
present.
- Your age.
- Other medical conditions. Some
medical conditions may cause you to heal slower.
- Your recovery
goals and commitment to and compliance with a physical rehabilitation
program.
- Whether you smoke, because smoking decreases the blood
supply throughout the body and slows the healing process.