Rotator Cuff Repair

(Rotator Cuff Surgery, Shoulder Surgery)

Procedure Overview

The rotator cuff consists of muscles and tendons that hold the shoulder in place. It is one of the most important parts of the shoulder. The rotator cuff allows a person to lift his/her arm and reach up. An injury to the rotator cuff, such as a tear, may happen suddenly when falling on an outstretched hand or develop over time due to repetitive activities. Rotator cuff degeneration and tears may also be caused by aging.

If the rotator cuff is injured, it may need to be repaired surgically. This may include shaving off bone spurs that are pinching the shoulder, or repairing torn tendons or muscles in the shoulder. Surgical techniques that may be used to repair a tear of the rotator cuff include arthroscopy, open surgery, or a combination of both. The goal of rotator cuff repair surgery is to help restore the function and flexibility of the shoulder and to relieve the pain that cannot be controlled by other treatments.

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The shoulder is a ball and socket joint, similar to the hip joint, and is made up of three bones:

• Humerus (upper arm bone)

• Scapula (shoulder blade)

• Clavicle (collar bone)

The upper arm is attached to the shoulder by the rotator cuff, which is a group of muscles and tendons that form a cuff around the shoulder joint. The joint capsule is another non-bone part of the shoulder joint, and is made up of a sheet of thin fibers, allowing for a wide range of motion.

Bursa are fluid-filled sacs located between the rotator cuff and the shoulder blade. They cushion and lubricate the shoulder.

This combination of bones, muscles, and tendons allows you to lift your arm, reach up, and throw.

Injuries to the shoulder are common. Athletes and construction workers often have rotator cuff injuries due to repetitive movement and overuse of the shoulder. The rotator cuff may be damaged from a fall or other injury to the shoulder. Damage may also occur slowly over time. The damage may be due to:

• Strains or tears in the rotator cuff.

• Inflammation of the bursa (bursitis) in the shoulder.

• Inflammation of the tendons (tendinitis) in the shoulder.

Recurrent pain, limited ability to move the arm, and muscle weakness are the most common symptoms.

If medical treatments are not satisfactory, rotator cuff repair surgery may be an effective treatment. Medical treatments for rotator cuff injury may include, but are not limited to, the following:

• Rest

• Nonsteroidal anti-inflammatory medications

• Strengthening and stretching exercises

• Steroid injections

Rotator cuff surgery may be performed using an arthroscope. An arthroscope is a small, tube-shaped instrument that is inserted into a joint. It consists of a system of lenses, a small video camera, and a light for viewing. The camera is connected to a monitoring system that allows the physician to view a joint through a very small incision. The arthroscope is often used in conjunction with other tools that are inserted through another incision.

An open repair may be performed if the rotator cuff injury cannot be repaired using arthroscopy. In some cases, a tendon graft and joint replacement may be necessary.

There may be other reasons for your physician to recommend rotator cuff repair.

As with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to, the following:

• Bleeding

• Infection

• Blood clots in the legs or lungs

The joint pain may not be relieved by the surgery. You may not recover full range of motion in the shoulder joint.

Nerves or blood vessels in the area of surgery may be injured, resulting in weakness or numbness.

There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

• Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.

• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.

• In addition to a complete medical history, your physician may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.

• Notify your physician if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).

• Notify your physician of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.

• Notify your physician if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.

• If you are pregnant or suspect that you are pregnant, you should notify your physician.

• You will be asked to fast for eight hours before the procedure, generally after midnight.

• You may receive a sedative prior to the procedure to help you relax. Because the sedative may make you drowsy, you will need to arrange for someone to drive you home.

• You may meet with a physical therapist prior to your surgery to discuss rehabilitation.

• Based upon your medical condition, your physician may request other specific preparation.

Rotator cuff repair may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending upon your condition and your physician’s practices.

Rotator cuff repair may be performed while you are asleep under general anesthesia, or while you are awake under local or regional anesthesia. If regional anesthesia is used, you will have no feeling from your shoulder down. The type of anesthesia will depend upon the specific procedure being performed. Your physician will discuss this with you in advance.

Generally, rotator cuff repair surgery follows this process:

1. You will be asked to remove clothing and will be given a gown to wear.

2. An intravenous (IV) line may be started in your arm or hand.

3. You will be positioned on the operating table.

4. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.

5. The skin over the surgical site will be cleansed with an antiseptic solution.

6. The physician will make an incision in the shoulder area. The incision will vary depending upon the type of surgery (open surgery, arthroscopy, or a combination of both) that may be performed.

7. The arthroscope (if used) will be inserted through the incision.

8. Other incisions may be made to introduce other small grasping, probing, or cutting tools.

9. Injured tendons and muscles will be repaired or replaced with a graft tendon from another part of the body.

10. Bone spurs (if present) will be removed.

11. The incision(s) will be closed with stitches or surgical staples.

12. A sterile bandage/dressing will be applied.

After surgery you will be taken to the recovery room for observation. Your recovery process will vary depending upon the type of anesthesia that is given and the type of surgery that is performed. The circulation and sensation of the arm will be monitored. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to your home.

You may be given an immobilizer or sling before you go home.

Once you are home, it is important to keep the surgical area clean and dry. Your physician will give you specific bathing instructions. The stitches or surgical staples will be removed during a follow-up office visit.

Take a pain reliever for soreness as recommended by your physician. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

To help reduce swelling, you may be asked to apply an ice bag to the shoulder several times per day for the first few days. You should keep the sling or immobilizer on as directed by your physician.

Your physician will arrange for an exercise program to help you regain muscle strength, flexibility, and function of your shoulder.

Notify your physician to report any of the following:

• Fever

• Redness, swelling, bleeding, or other drainage from the incision site

• Increased pain around the incision site

• Numbness or tingling in the affected arm or hand

You may resume your normal diet unless your physician advises you differently.

You should not drive until your physician tells you to. Other activity restrictions may apply. Full recovery from the surgery may take several months.

Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.