What Is Rotator Cuff Repair?
cuff is a combination of muscles and tendons that link your upper
arm bone, the humerus, to your shoulder blades. The rotator cuff also holds
your upper arm bone in place in your shoulder socket. The four muscles of the
rotator cuff are the supraspinatus, the infraspinatus, the teres minor and the
subscapularis. Each muscle is connected to the arm bone by a tendon. Rotator cuff repair is the
surgery used to repair a tear in one of these tendons.
Symptoms of Rotator Cuff Injuries
People of all ages injure their rotator cuffs. Some are good
candidates for surgery, while others will pursue different treatments.
You can injure your rotator cuff through wear and tear or
poor movement patterns over time. Slouching and chronically pushing your head
forward are two movement patterns that put your rotator cuffs at risk. As you
get older, the rotator cuff can be irritated or pinched by calcium deposits in
your shoulder area or bone spurs due to arthritis.
Repetitive stress is another culprit. Tennis players,
swimmers, and baseball pitchers are at risk for repetitive stress injuries of
the shoulder, as are carpenters and painters.
Rotator cuff injuries vary. Your tendons may be inflamed
from overuse, or partially or fully torn. You may also feel pain in your
shoulder from bursitis. This is a condition in which the bursa, a sac
filled with fluid that sits between your rotator cuff and your shoulder joint,
becomes inflamed and irritated.
Symptoms of a rotator cuff injury include:
- shoulder weakness
- not wanting to move your shoulder
- shoulder pain, especially when you lift, pull,
and reach behind your back or overhead
- decreased range of motion in your shoulder joint
Diagnosing Rotator Cuff Injuries
A medical history and a physical exam are extremely
important for proper diagnosis of rotator cuff injuries. You will need to get a
complete medical history. This is the time to tell your doctor about your
activity and exercise history. Your doctor will also perform a physical exam.
During the exam they will do a series of maneuvers to help determine the cause
of the pain you’re experiencing.
doctor will then order certain tests to confirm the diagnosis. These could include
shoulder X-rays, MRI, or an ultrasound. An MRI uses radio waves and magnetic fields to take
pictures of the structures and organs inside your body. An ultrasound uses
sound waves to form pictures of your insides. These tests all give slightly
different views of the internal structure of your shoulder.
on the exam findings and results of the imaging tests, your doctor will decide
whether or not rotator cuff repair surgery is your best treatment option. If
surgery is being considered, your surgeon may want to examine your shoulder
further by using an arthroscope. However, this is not always done. During an arthroscopy,
a small camera will be used to investigate your rotator cuff. During this
procedure, you’ll first receive a numbing agent for your shoulder. Then, your
doctor will poke a small hole in your shoulder and insert the camera, which is
linked to a video monitor. Your surgeon will use this camera to look at your
tendons, ligaments, and cartilage to determine whether surgery may help to
solve your shoulder problems.
Deciding on Rotator Cuff Repair Surgery
Surgery isn’t often the first recommended treatment for
shoulder injuries. Your doctor may first recommend rest, ice packs, and special
exercises. If the injury isn’t severe, these treatment approaches may be
enough. If a tendon is torn, rest and exercise may decrease the pain, but won’t
repair the tear. Surgery may be needed.
Your doctor will suggest that you discuss surgery with an
orthopedic surgeon if you:
- have shoulder pain that lasts for more than six
months, even after physical therapy
- have shoulder weakness that interferes with
- are an athlete
- use your shoulders and arms for your work
Rotator cuff repair surgery works best on recent injuries
rather than those caused by chronic conditions. See your doctor as soon as
possible after an injury has occurred.
Preparing for Rotator Cuff Surgery Repair
Resting and applying cold packs are good ways to ease your
shoulder pain while you wait for surgery. Your doctor or physical therapist may
also recommend certain exercises to help with pain.
You may want to take over-the-counter drugs, such as
aspirin, ibuprofen, and naproxen. These are anti-inflammatories as well as
painkillers. Make sure your doctor knows exactly what medications and
supplements you’re taking, as some may need to be discontinued before surgery.
Rotator Cuff Repair Procedure
You’ll either receive general or regional anesthesia. If you
have general anesthesia, you’ll sleep through the procedure. In the case of
regional anesthesia, you’ll be groggy but awake. Regional anesthesia will leave
your arm and shoulder numb, so you shouldn’t feel anything during surgery. This
numbness may last for up to 16 hours.
A rotator cuff repair is usually done with either an
arthroscope or as a surgery with an open, large incision or a very small
incision. If your surgeon repairs your rotator cuff with an arthroscope, they’ll
put the small camera in one hole, and then make one to three additional small
incisions for other instruments. The surgeon will use these instruments to reattach
your tendon to your bone.
Once the tendon is in the right place, your surgeon will
attach it with sutures. Often, surgeons will use small rivets called suture
anchors. These rivets may be made of metal or of a material that eventually
dissolves. Neither type of rivet will need to be removed. The sutures attach to
the rivets, reattaching the tendon to the bone from where it was torn.
If your rotator cuff tear is larger, you may need a
traditional surgery approach to fix it. This means a larger, open incision
instead of the arthroscopic approach. The incision could be 2.5 to 4 inches
long for a regular open repair, or 1.25 to 2 inches long for a mini-open
Open surgery, mini-open surgery, or an arthroscopy might be
necessary if your doctor wants to remove calcium deposits or a bone spur. A
bone spur is a bony growth that can press on nearby ligaments, nerves, or
tendons, causing pain. Bone spurs often develop as people age.
Once your incisions are stitched up, your healthcare team
will apply a clean dressing. If you had an arthroscopy, your doctor may show
you pictures of your shoulder and the repairs that were done.
Risks of Rotator Cuff Repair
Every surgery carries risks, including infection, nerve
damage, and excessive bleeding. In very rare cases, patients may have allergic
reactions to anesthesia or suffer from breathing problems during the procedure.
Talk to your doctor about any concerns you have regarding your surgery.
Recovery from Rotator Cuff Repair
After surgery, your doctor may instruct you to keep your arm
in a sling for four to six weeks. You may also need to wear a shoulder
immobilizer. There are many styles of shoulder immobilizers, but they look like
a short sleeve attached to a strap wrapped around your chest. This protects your
shoulder by holding it in place.
Your doctor may also
prescribe pain medications because shoulder surgery can be painful. Once you
start to heal, you may also want to begin a course of physical therapy. Therapy
will help restore your muscle strength and range of motion.
Recovery may take between three and six months, depending on
the extent and nature of your shoulder injury.
The chances of surgery reducing or eliminating shoulder pain
are very good. However, surgery may not restore your shoulder’s full strength.
With time and physical therapy you may regain function, but you may still have
weakness, stiffness, or chronic pain.
It will probably take a few months before you can play
sports or do other activities that require shoulder strength and full range of
Patients who smoke, are over the age of 65, have larger
tears, or have shoulders that were already weak before injury will likely
require more time to heal.
Preventing Rotator Cuff Injuries
It’s best to embark on a shoulder strength-training program
before you have problems in the first place. Strong shoulders reduce your risk
of injury. It’s especially important to strengthen the muscles around your
shoulder blades and those on the backs of the shoulders.
If you’ve already injured your rotator cuffs and have been
through surgery or other treatment, continually stretching and strengthening
your shoulders is important. Ask your doctor or physical therapist how to
develop a strengthening program. This is especially important for people whose
hobbies or jobs require repetitive motions that put them at risk for rotator
If there are a lot of repetitive movements in your job or
sport of choice, make sure to take plenty of rest breaks. If you begin to feel
any pain, apply a cold pack to the shoulder as soon as possible.