Isabella Carter
Rotator cuff surgery may be required if a person experiences a torn rotator cuff, which is a set of four small muscles in the shoulder that allow the upper arm to rotate. A rotator cuff tear can be caused by an injury, such as falling or heavy lifting, or from normal wear and tear over time. Small or partial tears may be treated with non-surgical methods such as physical therapy, rest, ice, and over-the-counter pain relievers. However, if non-surgical treatments do not effectively restore strength and function, surgery may be the only option, especially for full-thickness tears or large and complex tears. The decision to undergo surgery depends on various factors, including the severity of the tear, the patient's level of pain and activity level, and the surgeon's experience.
| Characteristics | Values |
|---|---|
| Surgery Type | Arthroscopy, Open Surgery, or a combination of both |
| Surgery Goal | To help restore the function and flexibility of the shoulder and to relieve pain that cannot be controlled by other treatments |
| Indications | Full thickness tear, partial thickness tear with failed conservative treatment, continued pain, very active lifestyle or overhead work/sports |
| Contraindications | Minor tears that can be treated with physical therapy and nonsurgical methods |
| Complications | Nerve injury, infection, deltoid detachment, stiffness, lack of pain relief, permanent loss of motion |
| Recovery | Sling for 6 weeks, driving prohibited for at least a month, full recovery within 6 months |
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What You'll Learn
Conservative treatments ineffective
Rotator cuff tears can occur when the tendon tears away from the bone of the upper arm. This can be caused by an injury, such as falling or heavy lifting, or from normal wear-and-tear and repetitive activities over many years. While minor tears may be treated without surgery, many rotator cuff tears require surgical intervention to heal properly.
If conservative treatments such as physical therapy or nonsurgical methods do not effectively restore strength and function within two to three months, surgery may be the only option. This is because tears tend to get larger over time, and delaying surgery can result in a partial tear becoming a full tear, or a small tear becoming larger, making it more difficult to repair.
Continued pain is the main reason for having surgery, as surgery is more likely to reduce pain and improve shoulder function and strength. Surgery may also be recommended if you are very active and use your arms for overhead work or sports. Other benefits of surgery include its ability to address other shoulder problems, such as a biceps tendon injury, loose bodies, or a torn labrum.
Arthroscopy, a minimally invasive technique, is currently the most common method for repairing rotator cuff tears. This procedure uses a small camera, called an arthroscope, which is inserted into the shoulder joint to guide miniature surgical instruments. Arthroscopy is less invasive than open surgery, as it requires smaller incisions and does not require the detachment or splitting of the deltoid muscle. It also reduces the amount of pain, nausea, and vomiting experienced by the patient, allowing them to recover at home within a few hours.
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Large or complex tears
Surgery is recommended for full-thickness tears, or for patients with partial-thickness tears who have not responded to conservative treatments such as physical therapy, rest, pain relievers, and steroid injections. Large tears can get larger over time, and delaying surgery can result in the progression of a partial tear to a full tear, or the propagation of a small tear to a larger one.
The success of rotator cuff surgery depends on how well the interface between the tendon and bone heals. Surgery to repair a torn rotator cuff involves re-attaching (stitching) the tendon back to its original site on the head of the humerus (upper arm bone). The larger the tear, the higher the risk of re-tear.
Arthroscopy is the least invasive method to repair a torn rotator cuff and is the most common approach. During arthroscopy, a small camera, called an arthroscope, is inserted into the shoulder joint, displaying a live video feed on a monitor that the surgeon uses to guide miniature surgical instruments. Arthroscopy allows for very small incisions, rather than the larger incision needed for open surgery, and does not require the detachment or splitting of the deltoid muscle.
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Continued pain
Rotator cuff tears tend to get larger over time, and delaying surgery can result in a partial tear becoming a full tear, or a small tear becoming larger. For this reason, if you have tried conservative treatments for two to three months and continue to have pain and difficulty with activities, surgery may be considered to repair the tear.
Rotator cuff surgery is performed arthroscopically in most cases. This involves inserting a small camera called an arthroscope, along with thin surgical tools, into your shoulder joint through very small incisions. The camera displays a live video feed on a monitor, allowing the surgeon to identify the damaged areas of the rotator cuff and guide the instruments to repair them. Arthroscopic surgery is the least invasive method of repairing a torn rotator cuff and is associated with a quicker recovery than open tendon repair.
However, it is important to note that most people do not experience instant pain relief from rotator cuff surgery. It may take a few months for your shoulder to start feeling better, and a full recovery can take up to six months. During this time, your doctor may advise you to take over-the-counter pain relievers or prescribe opioid painkillers, which come with a risk of addiction and should be taken only as directed.
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Active lifestyle
If you lead an active lifestyle, you may be at risk of a rotator cuff injury. The rotator cuff is a group of muscles and tendons that surround the shoulder joint, allowing you to lift your arm and rotate it. Injuries occur when a tendon connected to the head of the humerus (upper arm bone) is partially or completely torn away from the bone. This can happen suddenly, such as during a fall, or develop over time due to repetitive activities or aging.
If you experience a rotator cuff injury, you should seek medical attention promptly. While minor tears may not require surgery, many cases necessitate surgical intervention for proper healing. Your doctor will determine the best treatment option for you, and surgery may be offered if non-surgical methods, such as physical therapy, do not improve your pain and symptoms. Continued pain is the main reason for surgical intervention. Additionally, if you are very active and use your arms for overhead work or sports, surgery may be recommended to restore function and flexibility to your shoulder.
Rotator cuff repair surgery can be performed as an outpatient procedure, allowing you to return home on the same day. The surgery typically takes less than half an hour and is often done arthroscopically, using a small, tube-shaped tool called an arthroscope that is inserted through a small incision. This minimally invasive approach results in decreased pain and faster recovery. After surgery, your shoulder will be immobilized with a sling, and you will work with a physical therapist to regain your range of motion and strength.
The recovery process after rotator cuff surgery is gradual. You can expect to be in a sling for the first two to three weeks and begin physical therapy one week after surgery. Most patients report improved shoulder strength and reduced pain. However, a complete recovery can take several months, and participation in vigorous sports may be restricted for four to six months. During this time, you should follow your doctor's instructions and gradually increase your activities to ensure a successful outcome.
If you lead an active lifestyle and experience symptoms such as shoulder pain, reduced mobility, or weakness, it is important to seek medical advice. A physical therapist can work with you to design a regimen that focuses on strengthening exercises and improving flexibility, which can help manage your symptoms and delay or even prevent the need for surgery.
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Complications
Rotator cuff surgery is a common procedure performed by orthopedic surgeons to repair a torn rotator cuff. The rotator cuff is a set of four small muscles in the shoulder that allow the upper arm to rotate. When a rotator cuff is torn, the tendon part of the muscle tears away from the bone of the upper arm. While surgery is sometimes necessary, it is usually recommended that patients first undergo a trial of physical therapy to see if surgery can be avoided.
While rotator cuff surgery is considered to be of low morbidity, several potential complications can arise either during the procedure or during the postoperative recovery period. Complications can depend on the surgical approach (arthroscopic or open) or be patient-dependent. Overall, complications after rotator cuff repair are not common and occur in about 10-11% of cases.
- Nerve injury: This typically involves the nerve that activates your shoulder muscle (deltoid). Iatrogenic nerve injuries are likely an underreported complication, with estimates of 1-2% of nerve injuries occurring after rotator cuff surgery.
- Infection: Deep infection after arthroscopic or mini-open surgery is rare, occurring in only 0.16 to 1.9% of patients. Patients are given antibiotics during the procedure to reduce the risk of infection.
- Deltoid detachment: During an open repair, the deltoid shoulder muscle may be partially detached to provide better access to the rotator cuff. It is stitched back into place at the end of the procedure and must be protected during rehabilitation to allow it to heal.
- Stiffness: Stiffness is common after rotator cuff surgery, with a retrospective study finding that 20% of patients experienced stiffness following an open rotator cuff operation. Early rehabilitation is key to lessening the likelihood of permanent stiffness or loss of motion.
- Stroke, heart attack, pneumonia, or blood clot: As with any surgery involving anesthesia, there is a slight risk of these complications.
- Damage to adjacent nerves and blood vessels: One study found that 1-2% of patients undergoing rotator cuff surgery experienced nerve damage.
- Dislodgement of rotator cuff anchors: In a study of 30 patients who underwent rotator cuff surgery with bioabsorbable anchors, nine patients experienced dislodgement of the anchors from the humeral head, along with a full-thickness supraspinatus tendon retear.
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Frequently asked questions
The rotator cuff is a set of four small muscles in the shoulder that allow the upper arm to rotate. When a rotator cuff is torn, the tendon part of the muscle tears away from the bone of the upper arm.
Non-surgical treatment options include rest, icing the area, over-the-counter pain relievers, and physical therapy.
Surgery may be needed if non-surgical treatments do not provide relief from pain and improve shoulder function and strength. It is also recommended for a full-thickness tear or in patients with a partial tear who have not responded to conservative treatment for two to three months.
