Rotator cuff surgery is a medical procedure used to treat people with a torn rotator cuff. The surgery is usually recommended in cases of a very severe injury where nonsurgical treatment has not sufficiently improved the strength and movement of the shoulder. The surgical procedure used to repair torn rotator cuff tendons involves removing loose tendon and bursa fragments and any other debris in the shoulder which inhibits rotator cuff movement. This provides room to ensure the rotator cuff tendon isn’t pinched or irritated. Sometimes this includes removing or shaving bone spurs which develop on the tip of the shoulder blade.
Sometimes the surgery requires sewing the supraspinatus tendon’s torn edges together and attaching it to the tip of the humerus. Arthroscopic surgery is commonly used to repair the rotator cuff. However, in some cases, repairing the damage requires a larger incision and the surgeon is forced to do open-shoulder surgery.
After the surgery, the doctor will prescribe pain medication to reduce the discomfort during the healing process. The patient’s arm will be placed in a sling for protection and a program of physical therapy is required to ensure a successful recovery. When the anesthesia wears off, the patient will be instructed to begin doing a series of exercises which flex and extend the hand, wrist and elbow. The range of motion of the shoulder joint is then tested. Depending on the severity of the tear and the complexity of the surgical repair, a physical therapist will lead the patient through active exercise and stretches beginning after about 6 to 8 weeks. The process begins with strengthening exercises and gradually progresses to light then heavier weights.
Surgery to repair the rotator cuff is usually recommended when a sudden injury causes the rotator cuff to tear. In those cases, doing the surgery as soon after the injury as possible is the best course of action. Surgery is also recommended when the rotator cuff is completely torn and leads to severe shoulder weakness. Many doctors recommend surgery when conservative nonsurgical treatment for 3 to 6 months fails to produce improvement or the patient’s job requires full shoulder function and strength. Young patients and those in good physical condition who can fully recover from the surgery and are willing to commit to a rigorous physical rehabilitation program are also good candidates for the surgery.
Surgical repair of the rotator cuff isn’t always the best choice. The procedure has a lower rate of success if it’s performed long after the injury occurs, the tear is very large or the rotator cuff tendon tissue is thinned or frayed. There are also a number of common risks associated with the surgery. They include the incision or the shoulder joint becoming infected, permanent pain or stiffness and deltoid tendon or muscle damage. Sometimes the surgery causes damage to nerves or blood vessels, complex regional pain syndrome develops or the tendons tear again or don’t heal properly and require another surgery.
For tears larger than 2 inches or if more than one tendon is torn, grafting or patching can help. Debridement and smoothing are also good options because there’s less risk and less rehabilitation is required. Older, less active people with rotator cuff tears that aren’t painful and don’t cause sleep problems or significant weakness can safely opt to forgo surgery. They should only consider surgery if their symptoms begin to get worse. However, not repairing severe rotator cuff tears through surgery can lead to cuff tear arthropathy. This painful progressive form of arthritis is marked by a significant loss of flexibility, strength and function of the shoulder.
