Rotator cuff repair

• Description

  The rotator cuff is a group of muscles and tendons that form a cuff over the shoulder joint. These muscles and tendons hold the arm in its "ball and socket" joint and help the shoulder to rotate. The role of the tendons is to hold the powerful shoulder muscles to the shoulder and arm bones. The tendons can be torn from overuse or injury.

  Your doctor will first check your shoulder with a small camera (arthroscope) to look at the tear and determine if it can be fixed. The arthroscope is inserted into the shoulder through a small poke-hole. The camera is connected to a video monitor. The surgeon looks around the entire joint to check the cartilage, tendons, and ligaments of your shoulder.

  After evaluating the shoulder joint, the surgeon places the camera in the space above the rotator cuff tendons, called the subacromial space. The surgeon can check the area above the rotator cuff, clean out inflamed or damaged tissue, and remove a bone spur (subacromial spur).

  If a tear is going to be fixed, the surgeon may perform the surgery with a larger, open incision. Other surgeons use the arthroscope and 1 to 3 additional small poke-holes or smaller incisions to perform the surgery. The additional small incisions allow the surgeon to insert other instruments to repair damaged tissue.

  The goal is to attach the tendon back to the bone where it tore off. The tendon is attached with sutures. Small rivets (called suture anchors) are often used to help attach the tendon to the bone. The suture anchors can be made of metal or material that dissolves over time, and do not need to be removed.

  At the end of the surgery, the incisions are closed, and a dressing is applied. If arthroscopy was performed, most surgeons take pictures of the procedure from the video monitor to show you what was found and what was done.

• Why the Procedure Is Performed

  Rotator cuff repair may be recommended for shoulder problems such as:

  • Torn rotator cuff with weakness and pain
  • Pain, especially using the arm overhead
  • A bone spur or inflammation around the rotator cuff
• Risks

  The risks for any anesthesia are:

  • Allergic reactions to medications
  • Problems breathing

  The risks for any surgery are:

  • Bleeding
  • Infection
  • Nerve damage

  Additional risks include:

  • Stiffness of the shoulder
  • Failure of the surgery to relieve symptoms
  • Failure of the repair to heal
  • Weakness of the shoulder
• After the Procedure

  Surgery to repair a torn rotator cuff is usually very successful at relieving pain in the shoulder. The procedure may not always return strength to the shoulder. Rotator cuff repair can require a long recovery period, especially if the tear was large.

  In many cases, arthroscopy reduces the need to surgically open the shoulder joint. This can result in less pain and stiffness. In cases of repair, the body still needs to heal after arthroscopic surgery, just as if it were open surgery, so the overall recovery time will still be long.

• Outlook (Prognosis)

  The recovery can take anywhere from 3 to 6 months, depending on the size of the tear and other factors. You may have to wear a sling for 1 to 6 weeks after surgery. Pain is usually managed with medications.

  When you can return to work or play sports will depend on the surgery that was performed, but it will usually take several months to resume your regular activities.

  Physical therapy may help you to regain the motion and strength of your shoulder. The length of therapy will depend on the repair that was performed.

• References

  Matsen FA III, Fehringer EV, Lippitt SB, Wirth MA, Rockwood CA Jr. Rotator cuff. In: Rockwood CA Jr, Matsen FA III, Wirth MA, Lippitt SB, eds. The Shoulder. 4th ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 17.

  Miller RH II, Dlabach JA. Shoulder and elbow injuries. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 44.

Review Date: 7/10/2009

Reviewed By: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Dept of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.