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Rotator cuff repair
Definition
Rotator cuff repair is a type of surgery to fix a torn tendon in the shoulder. The procedure can be done with a large ("open") incision or with shoulder arthroscopy, which uses small button-hole sized incisions.
Description
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.
Your doctor will first check your shoulder with a small camera (arthroscope) to look at the tear and determine if it can be fixed. The arthroscope is 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 check 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 check 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 to 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:
- Allergic reactions to medications
- Problems breathing
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 may not always return 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 result in less pain and stiffness. In cases of repair, the body still needs to heal after arthroscopic surgery, just as if it were open surgery, so the overall recovery time will still be long.
Convalescence
The recovery can take anywhere from 3 to 6 months, depending on the size of the tear and other factors. You may have to wear a sling for 1 to 6 weeks after surgery. Pain is usually managed with medications.
When you can return to work or play sports will depend on the surgery that was performed, but it will usually take several months to resume your regular activities.
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.
Review Date:5/3/2007
Reviewed By:Robert A. Cowles, M.D., Assistant Professor of Surgery, Columbia University College of Physicians and Surgeons, New York, NY. Review provided by VeriMed Healthcare Network.
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