Why get your rotator cuff repaired?
Your arm is kept in your shoulder socket by your rotator cuff, a group of muscles and tendons that help the shoulder rotate and move. These muscles come together as tendons to form a covering around the head of the humerus, the upper arm bone.
Surgery to repair a torn rotator cuff generally involves reattaching the tendon to the head of the humerus. However, a partial tear might only need a process called debridement, in which a surgeon trims the area of bad tissue.
People generally need to get their rotator cuffs repaired either because they've injured it or because the muscles have deteriorated over time. For example, someone might acutely tear their rotator cuff after falling on their shoulder or falling on an outstretched arm. Some estimates that show, after 60, more than 50 percent of people have a rotator cuff tear.
Rotator cuff injuries are common in the working population, with rotator cuff disorder ranking second only to back and neck pain in frequency of occurrence in the workplace.
In about 50 percent of patients who suffer from rotator cuff pain, nonsurgical treatment relieves pain and improves function in the shoulder. Shoulder strength, however, does not usually improve without surgery. At the same time, it does not always return with surgery.
What happens during surgery?
To begin the surgery, you'll either be placed under general anesthesia and go to sleep, or you'll have a regional anesthetic, in which your shoulder and area around it is numb.
There are three techniques most commonly used to repair a rotator cuff, including an open repair, an arthroscopic repair and a mini-open repair.
An open repair is generally used if the tear is large or complex. During surgery, your surgeon will cut over the shoulder and detach your deltoid, your shoulder muscle. The surgeon will then look over the tear and tie the rotator cuff tendon back down.
During an arthroscopic repair, your surgeon will generally make small cuts around your shoulder. Your surgeon uses a small camera to see inside your joint and to look at the structures within your shoulder. This will also allow your surgeon the ability to identify the condition of your shoulder, along with your cartilage and soft tissue.
Each surgeon will differ on his or her surgery preference and how he or she performs the specific surgery. An arthroscopic repair is generally outpatient procedures and is the least invasive method to repair a rotator cuff.
Does it hurt?
Before the surgery, most people are either in pain or have weakness in their shoulder. Your surgery should alleviate that, although it's not an absolute. During the surgery, you might receive a nerve block anesthesia. This will numb your shoulder and arm and can, in some patients, help better ensure a positive outcome.
Most people are in pain after surgery for up to two weeks. You likely will receive a prescription for pain narcotics after surgery.
One of the biggest concerns with a rotator cuff repair is that the tendon will retear. Small twinges during physical therapy are common and usually don't mean the repair has failed. It is not easy to tell if the rotator cuff tendon repair has failed or not. The symptoms of pain or loss of strength are common after rotator cuff surgery while the tendons are healing.
What are the risk factors?
The risk factors for any surgery include bleeding and infection.
With a rotator cuff repair, one of the biggest risks is that you will retear the tendon. The risk of retear is a debated topic, with estimates of how many patients retear their tendons ranging from 5 percent to 90 percent.
Regardless, it's important to listen to your doctor and physical therapy and understand your limitations. The factors that contribute to a retear include a person's age, with older patients having a higher risk of retear; how long the tear has been there; and the quality of tissue. If the tear is left untreated for a long time, this can cause the muscle to turn into fat, which can result in the repair not healing as well.
What's the recovery time?
Generally, after between three and four months, you can return to normal activities.
When you wake up from surgery, you likely will be in a sling. This sling is to protect your repair. It's important to listen to your surgeon's instructions regarding the sling. For example, some surgeons will recommend you wear the sling while you sleep. Others might not. It will also depend on your level of injury and the extent of your repair.
Your range of motion will be quite limited directly after surgery. Your doctor will talk with you about the activities that you're allowed to do, versus things you should steer clear of.
Your doctor will likely recommend that you undergo physical therapy. Some insurance providers aren't as willing to cover physical therapy. Talk with your doctor about what your insurance allows, and what exercises you can do outside of physical therapy to ensure your repair heals.
Between two weeks to six weeks after surgery, you will have limited range of motion in your shoulder. Depending on the quality of your muscle, you might start some movement.
You'll be allowed to take a shower between two days and two weeks after your surgery, depending on your surgeon's recommendations. You likely won't be allowed to submerge your shoulder in a hot tub, lake or pool until about six weeks, although this will also vary.
Smoking can cause a person not to heal as quickly. There's also some debate about whether patients with workers' compensation claims have worse outcomes.
What's the follow-up?
You likely will see your surgeon about 10 to 14 days after surgery. You will have periodic doctor's visits after this, generally after six to eight weeks and then after about three months. After a year, you likely won't need to see your surgeon, unless you're experiencing pain or complications.
The recovery period for a rotator cuff repair can take a long time, especially if the tear was large. It's important to listen to your doctor, follow your physical therapy instructions and remain patient with your limitations. In some cases, rotator cuff tears might not fully heal, leading to stiffness, weakness and chronic pain. Risk of these complications is more likely when people don't perform post-surgery exercises or ignore medical professional's instructions.
Sources: Dr. Chris Espinoza, an orthopedic surgeon at McBride Orthopedic Hospital; American Academy of Orthopaedic Surgeons; U.S. National Library of Medicine; The Journal of Bone & Joint Surgery; International Journal of Sports Physical Therapy; The Mayo Clinic; Clinical Orthopaedics and Related Research; Anesthesiology, the Journal of the American Society of Anesthesiologists; John Hopkins Medicine.