Rotator Cuff SurgeryBy
Sarah Lewis, PharmD
What is rotator cuff surgery?
Rotator cuff surgery is the surgical repair of a damaged rotator cuff tendon. The rotator cuff tendons are tough piece of connective tissue that control the motion of your shoulder joint. Your shoulder joint is formed where your upper arm bone (humerus), shoulder blade (scapula), and collarbone (clavicle) meet. Tendons attach a group of four muscles to these bones to form your rotator cuff.
Rotator cuff repair can help restore pain-free range of motion and full function in a damaged shoulder joint.
Rotator cuff tears are common, but not all rotator cuff tears require surgery. Rotator cuff surgery is a major surgery with serious risks, a long recovery, and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having shoulder surgery.
Types of rotator cuff surgery
The types of rotator cuff surgery include:
Complete tear or full-thickness tear repair. A complete tear is when your tendon detaches completely from the bone. Your surgeon will reattach your tendon to the bone.
Partial tear repair or debridement. Partial tears often begin with fraying and inflammation of your tendon. Your surgeon may only need to trim and smooth your tendon for this type of repair.
Other procedures that may be performed
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Your doctor may perform other procedures to treat certain coexisting conditions. These include:
Bone fracture or dislocation repair. Injuries can cause rotator cuff tears requiring surgical repair of both the tear and the injury. These injuries include a fractured collarbone, a fractured humerus, and shoulder dislocations.
Bursectomy or bursa sac repair to treat a damaged bursa sac, which can occur with a damaged tendon. Your bursa sac provides cushioning for your joint.
Shoulder replacement to treat osteoarthritis of your shoulder. Shoulder replacement can involve a partial replacement of just one part of your bone or a total replacement of your entire shoulder joint.
Soft tissue repair to treat damage to your shoulder muscles.
Why is rotator cuff surgery performed?
Your rotator cuff is a group of muscles and tendons that surround your shoulder joint. The rotator cuff allows you to lift your arm and rotate your shoulder. Rotator cuff damage is often caused by aging, overuse or injury. This can result in a tendon tear, tendinosis (degeneration), tendinitis (inflammation of your tendon), and bursitis (inflammation of your bursa sac).
Your doctor may recommend surgery to treat a damaged rotator cuff. Your doctor may only consider rotator cuff surgery if other treatment options with less risk of complications have not worked. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on surgery.
Your doctor may recommend rotator cuff surgery if your tendon tear is:
Caused by a recent injury
Causing loss of function in your shoulder
Causing symptoms, such as pain, that last for six to 12 months
Larger than three centimeters (cm), or a little more than an inch
Diminishing your quality of life and nonsurgical management, such as physical therapy, is not working
Who performs rotator cuff surgery?
An orthopedic surgeon will perform your rotator cuff surgery. Orthopedic surgeons specialize in surgical treatment of diseases of the bones and connective tissues.
How is rotator cuff surgery performed?
Your orthopedic surgeon will perform your rotator cuff surgery in a hospital or outpatient surgical setting using one of the following approaches:
Minimally invasive surgery is a procedure performed by inserting special instruments and an arthroscope through small incisions in your shoulder. An arthroscope is a thin, lighted instrument with a small camera. The camera transmits pictures of the inside of your body to a video screen viewed by your surgeon as he or she performs the surgery. Minimally invasive surgery can involve a faster recovery and less pain than open surgery. This is because it causes less damage to tissues, such as muscle. Your surgeon makes small incisions instead of a larger one used in open surgery. Your surgeon threads surgical tools around tissues instead of cutting through or displacing them as in open surgery.
Mini-open surgery uses newer technology and combines minimally invasive arthroscopic techniques with a smaller open procedure. The incision is one to two inches long, which is smaller than a standard open surgery incision. This technique allows your surgeon to make more extensive repairs than are possible with minimally invasive surgery. However, it causes less damage than traditional open surgery because your muscles remain attached during the surgery.
Open surgery is performed by making a large incision in the shoulder. Open surgery allows your surgeon to directly view and access the surgical area. Open surgery requires a larger incision and involves more cutting and displacement of muscle and other tissues. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery because it causes more trauma to tissues. Despite this, open surgery may be a safer or more effective method for certain patients or conditions.
Your surgeon will determine which type of surgery is best for you and how long you need to stay in the hospital or surgical center based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different rotator cuff surgeries and ask why your surgeon will use a particular type of surgery for you.
Types of anesthesia that may be used
Your surgeon will perform rotator cuff surgery using either regional anesthesia or general anesthesia, depending on the specific procedure.
General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain. You may receive a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block is an injection or a continuous drip of a liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
Regional anesthesia is also known as a nerve block. Your anesthesiologist or nurse anesthetist will inject an anesthetic around certain nerves in the neck so you do not feel anything in the affected area. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.
What to expect the day of your rotator cuff surgery
The day of your surgery, you can generally expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member if possible. The surgical team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will receive.
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube will be placed in your windpipe to protect and control your breathing during general anesthesia. You will not feel or remember this or the surgical procedure as they happen.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of rotator cuff surgery?
As with all surgeries, rotator cuff surgery involves risks and potential complications. Complications may become serious and life threatening in some cases. Complications can develop during the procedure or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.
Infection and septicemia, which is the spread of a local infection to the blood
Potential complications of rotator cuff surgery
Complications of rotator cuff surgery can be serious and include :
Deltoid detachment, which is a complication of open surgery. In open surgery, your surgeon moves the deltoid muscle out of place in order to reach your rotator cuff, and then stitches it back in place. It is vulnerable to injury and detachment until it heals.
Nerve damage, which can lead to numbness and tingling in the affected arm
Stiffness and loss of range of motion, which is usually temporary and responds well to aggressive physical therapy
Tendon re-tear, which is more common with larger tears
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery. This includes physical therapy, occupational therapy, and other rehabilitation treatments.
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my rotator cuff surgery?
You are an important member of your own healthcare team. The steps you take before surgery can improve your outcome after the procedure. You can prepare for rotator cuff surgery by:
Answering all questions about your medical history and medications you take. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing varies depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing weight before the surgery through a healthy diet and exercise plan
Not eating or drinking just prior to surgery as directed. Your doctor may cancel your surgery if you eat or drink too close to the start of the procedure because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Showering with an anti-septic soap the night before and the morning of surgery.
Taking or stopping medications exactly as directed. For rotator cuff surgery, this may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your preoperative appointments. Questions can include:
Why do I need rotator cuff surgery? Are there any other options for treating my condition?
Which type of rotator cuff surgery procedure will I need?
How long will the surgery take? When can I go home?
What kind of restrictions will I have after the surgery? When can I return to work and other activities?
What kind of assistance will I need at home?
What medications will I need before and after the surgery? How should I take my usual medications?
How will you manage my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my rotator cuff surgery?
Knowing what to expect can help make your road to recovery after rotator cuff surgery as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
Depending on the type of procedure, you may go home on the same day if you are recovering well. In other cases, a hospital stay of one to two days may be required.
Recovery after surgery is a gradual process. Recovery time varies depending on the specific procedure, type of anesthesia used, your general health, age, and other factors. You may need to wear a sling for several weeks after your surgery. Your doctor will likely refer you to physical therapy and an exercise rehabilitation program to help you recover. Full recovery times range from three to twelve months.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor and care team will manage your pain so you are comfortable and can get the rest you need. Contact your doctor if your pain gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after rotator cuff surgery. Call your doctor if you have concerns or questions between appointments. Call your doctor right away or seek immediate medical care if you have:
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, dizziness, unresponsiveness, or confusion
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate, have a bowel movement, or pass gas
Numbness of the affected arm
Pain that is not controlled by your pain medication
Unexpected drainage, pus, redness or swelling of your incision
How might a rotator cuff surgery affect my everyday life?
Rotator cuff surgery may cure your condition or reduce your symptoms so you can lead an active, normal life. For example, rotator cuff surgery may relieve your pain and restore strength to your shoulder. However, rotator cuff surgery will not prevent future damage. You can help prevent further rotator cuff problems by:
Carrying heavy objects close to your body
Keeping pressure off your shoulder by sleeping on the opposite side
Practicing good posture
Strengthening your shoulder muscles with exercises and physical therapy as recommended by your healthcare provider
Using proper body mechanics when lifting heavy objects
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