Rotator cuff repair

Surgery Overview

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Surgery may be used to treat a rotator cuff disorder if the injury is very severe or if nonsurgical treatment has failed to improve shoulder strength and movement sufficiently.

The rotator cuff is a group of four tendons and the related muscles that stabilize the shoulder joint and allow you to raise and rotate your arm. The shoulder is a ball-and-socket joint with three main bones: the upper arm bone (humerus), the collarbone (clavicle), and the shoulder blade (scapula). These bones are held together by muscles, tendons, ligaments, and the joint capsule. The rotator cuff helps keep the arm bone seated into the socket of the shoulder blade.

Surgery to repair a torn rotator cuff tendon usually involves:

• Debridement, in which loose fragments of tendon and bursa and other debris from inside the irritated, injured, or torn area of the confined space in the shoulder where the rotator cuff moves (subacromial space) are removed.
• Making more room in the subacromial space so that the rotator cuff tendon is not pinched or irritated. If necessary, this process may include shaving bone or removing growths on the upper point of the shoulder blade (subacromial smoothing).
• Sewing the torn edges of the supraspinatus tendon together to the top of the upper arm bone (humerus).

In open shoulder surgery, a surgeon makes a large incision [ to ] in the shoulder to open it and view the shoulder directly while repairing it. One open-surgery technique, sometimes called mini-open, allows the surgeon to reach the affected tendon by making a small incision to split the deltoid muscle. This method reduces your chances of problems from a deltoid injury.

Open-shoulder surgery often requires a short stay in the hospital.

General anesthesia or a nerve block may be used for these types of surgical repair.

Complete tears can sometimes be repaired with arthroscopic surgery.

What To Expect After Surgery

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Discomfort after surgery may decrease with taking pain medications prescribed by your health professional.

The arm may be protected in a sling for a defined period of time, especially when at risk of additional injury.

Physical therapy after surgery is crucial to a successful recovery. A rehabilitation program may include the following:

• As soon as you awake from anesthesia, you may start doing exercises that flex and extend the elbow, wrist, and hand.
• The day after surgery, if your health professional allows, passive exercises that move your arm may be done 4 to 5 times daily (a machine or physical therapist helps the joint through its range of motion).
• More aggressive and progressive exercises and stretches, with the assistance of a physical therapist, may start 2 to 12 weeks after surgery, depending on the type of surgery. The necessity of these exercises depends on the severity of your tear and the complexity of the surgical repair.
• Unassisted range-of-motion exercises with light weights can start a few months after surgery.

Why It Is Done

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Surgery to repair a rotator cuff is done when:

• A complete rotator cuff tear causes severe shoulder weakness.
• The rotator cuff has failed to improve with conservative nonsurgical treatment alone (such as physical therapy).
• You need full shoulder strength and function for your job or activities, or you are young.
• You are in good enough physical condition to recover from surgery and will commit to completing a program of physical rehabilitation.

How Well It Works

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Rotator cuff repair surgery restores more strength to the shoulder than arthroscopic debridement and decompression alone. The more strength that is restored, the more shoulder function you will have.

Risks

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In addition to the risks of surgery in general, such as blood loss or problems related to anesthesia, complications of rotator cuff surgery may include:

• Infection of the incision or of the shoulder joint.
• Persistent pain or stiffness, which may get better over time.
• Damage to the deltoid tendon or muscle (if the deltoid is detached, additional surgery may be necessary to repair it).
• The need for repeated surgery because tendons do not heal properly or tear again.
• Nerve damage (uncommon).
• Reflex sympathetic dystrophy (rare).

What To Think About

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Massive tears [greater than or involving more than one rotator cuff tendon] often cannot be repaired. Grafting and patching procedures are possible, but they are not much better at restoring strength than debridement and decompression, which is less risky and requires less rehabilitation.

Less active people (usually those older than 60) with confirmed rotator cuff tears that do not cause pain, significant weakness, or sleep problems can safely go without surgery unless symptoms become worse.

• Some people who do not have surgery to repair severe rotator cuff tears develop cuff tear arthropathy, a condition of progressive arthritis, pain, and significant loss of strength, flexibility, and function.
• The risk of developing cuff tear arthropathy may be less serious than the risks of surgery for a less active person older than 70.
• In some cases, arthroscopic debridement and smoothing adequately relieves pain and restores enough function to allow daily activities, and open surgery is then not necessary.

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

References

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Other Works Consulted

• Devinney DS, et al. (2005). Surgery of shoulder arthritis. In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions, 15th ed., vol. 1, pp. 995–1015. Philadelphia: Lippincott Williams and Wilkins.

• Husni EM, Donohue JP (2005). Painful shoulder and reflex sympathetic dystrophy syndrome. In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions, 15th ed., vol. 2, pp. 2133–2151. Philadelphia: Lippincott Williams and Wilkins.

• Krishnan SG, Hawkins RJ (2003). Rotator cuff and impingement lesions in adult and adolescent athletes. In JC DeLee, D Drez Jr., eds., DeLee and Drez's Orthopaedic Sports Medicine, Principles and Practice, 2nd ed., vol. 1, pp. 1065–1095. Philadelphia: W.B. Saunders.

• Speed C, Hazleman B (2005). Shoulder pain. Clinical Evidence (13):1555–1571.

Credits

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Author	Colleen Cronin
Author	Lila Havens
Editor	Katy E. Magee, MA
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Michele Cronen
Primary Medical Reviewer	William M. Green, MD - Emergency Medicine
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	Kathie Hummel-Berry, PT, PhD - Physical Therapy
Last Updated	February 10, 2006