The rotator cuff surrounds the humeral head (ball) of the shoulder and is formed by blending of the tendons of four rotator muscles. These tendons fuse with the fibers of the joint capsule and help to stabilize the ball in its socket. These tendons are important in making the fine adjustments necessary in all movements of the shoulder joint. Degeneration or tears in the rotator cuff can cause pain and loss of the motion and strength in the shoulder. Rotator cuff failure may cause persistent aching pain with use and at rest (especially at night), loss of the ability to elevate the arm above shoulder level and significant weakness in lifting, pushing and pulling. Chronic rotator cuff tears may enlarge and, in some cases, can lead to disabling arthritis of the shoulder. Some rotator cuff tears produce surprisingly few symptoms. Common symptoms are shoulder, arm and sometimes neck pain, weakness, catching and giving way. It is often painful at night. Not everyone with a rotator cuff tear needs surgery. It depends on the amount of pain you have, the strength you have and the demands that you place on your shoulder. We must also consider your overall medical condition in making the best recommendation for you as a whole person.
Non-operative Treatment.
We rarely perform surgery for tears of the rotator cuff without a trial of non-operative therapy either under our direction or before you have been seen here. Exceptions involve acute severe tears with significant weakness in which case non-operative care is unlikely to succeed. Non-operative treatment can include activity modification, pain and anti-inflammatory medication, steroid injection and physical therapy for gentle stretching and strengthening. The purpose of non-operative treatment is to decrease pain and inflammation and to maximize shoulder motion, strength and function. A rotator cuff tear which causes unrelenting pain, limitation of motion, and weakness, may be repaired surgically. Rotator cuff repair is a major operative procedure. Although you may feel better within the first weeks and months after surgery, it may take as much as nine to 12 months for you to fully recover from surgery, and rehabilitate your shoulder to the point that your activities will not be significantly limited. Depending on the size of the tear, your age, general health, compliance and other factors; recovery may be faster
Rotator Cuff Surgery
Prior to your operation, you should understand the procedure and the limitations that must be imposed after surgery. Before surgery, you and your family need to be prepared for your needs after the operative procedure. It is critical that you protect your shoulder while the repair is healing.
Usually a light general anesthetic is used. This is supplemented with a nerve block to numb your shoulder and arm and when you awaken, you will generally have little or no pain in your shoulder. The nerve block is called an interscalene block, a technique which numbs your shoulder and arm by injecting a local anesthetic between your shoulder and your neck. At surgery, we will repair the tear and remove any bone or scar tissue that may be contributing to your rotator cuff problem. To every degree possible, we will try to securely repair cuff tissue back to its normal attachment. Sometimes, however, the tissue is of insufficient quality (too weak) for a repair. In that case, other techniques can be used to repair/reinforce the damaged cuff but usually the cuff can be repaired. With current techniques, cuff repairs are almost always done arthroscopically, although if needed, a larger incision will be made. The operation takes 1-2 hours in uncomplicated cases depending on other commonly associated problems such biceps tendonitis, bone spurs on the bone above the cuff (the acromion) and AC joint arthritis. It is important to take care of all these issues at the time of surgery. Rotator cuff surgery is typically done as out-patient surgery.
I do not recommend any active (moving your shoulder with your shoulder muscles) use of the operated arm away from the side or for lifting, pushing, or pulling for six weeks while the tendon is starting to heal back to bone. The exact timing of your rehabilitation will be adjusted based on the surgical findings. The goal of rehabilitation during the first three months in primarily to protect the repair and regain motion gradually. We will begin gentle muscular strengthening, but the shoulder must be carefully protected for many months afterward The hand may be used for light activity (for example: reading and eating) within days after surgery in most cases. You will be given exercises to do to safely allow your shoulder to move immediately after surgery. You will not be able to drive for at least 2 weeks and possibly as much as one month depending on the specific nature of your surgery.
I like to see our patients who have had a rotator cuff repair approximately 2-3 days after surgery to change your bandages and to make certain that motion has been maintained. Sutures are removed after approximately 10-14 days. Your visit six weeks after surgery is when we decide if your shoulder has healed adequately to advance your exercises and to lose your sling. Usually a formal physical therapy program begins then so that you have excellent guidance during this critical period of your recovery. The healing rotator cuff tendons will gain strength slowly, but progressively. We must stay in touch to advance your activities as safely as possible. Follow up typically continues every 6 weeks or so for about six months post op.
Surgical Risks:
The risks of the operation are those of any major surgical procedure. There is the risk of infection either superficial (like skin) or deep (as in the joint). There is risk of injury of vital structures such as blood vessels or nerves which may lead to bleeding, numbness, weakness, or paralysis. Occasionally, surgery is not helpful in relieving the symptoms; rarely the shoulder works less well after surgery. Symptoms may persist due to recurrence of the rotator cuff tear. We must remember that the repair cannot restore the tendon to normal strength. There are major risks to other systems such as the heart, kidney or lungs, and complications involving these organs can endanger life. Other risks are present (such as allergic reactions) but are more rare. If you have specific questions about the procedure or risks, please ask your doctor and he will explain in greater detail.
Results of rotator cuff surgery:
The greatest benefit achieved after rotator cuff surgery is pain relief. Often an increase in shoulder comfort is realized even if repair is impossible. According to long-term follow-up studies, greater than 90% of patients have been satisfied with the outcome of their cuff repairs. The smaller the rotator cuff tear at the time of repair, the greater the chance that your function in strength and range of motion will be good or excellent. After rotator cuff repairs, the shoulder will gain motion and strength for more than one year after the operation. Please be patient with your body's healing process!