Arthroscopic Rotator Cuff Repair

The rotator cuff is a group of four muscles that allow you to move your shoulder.  These muscles attached to the shoulder blade and then connect to the arm bone. You cannot see these muscles, as they are deep beneath your deltoid, but provide the strength to let you move your arm normally.
Not all rotator cuff tears need surgery
Did you tear your rotator cuff ? What to look for.
Rotator Cuff Tears: Do I need to fix it ?

How does the rotator cuff tear ?

Rotator Cuff TearThe rotator cuff can tear when excessive force is applied to the muscles of the shoulder.  The chance for this to happen increases with age, especially over the age of 60.  This happens as tendons in our bodies tend to become more brittle over time, losing their normal ‘stretchiness’ or elasticity.  

Tears can occur with lifting heavy objects, injuries to the shoulder, or a result of progressive damage to the tendon with time. A common story I hear in my office is when someone tries to pull a suitcase off the luggage belt at the airport. The usual symptoms with tears are shoulder pain, pain with activities, pain at night, limited range of motion and weakness.  Not all tears are the same, so it is hard to compare with a friend who said their had a tear in their shoulder.

Tears, unlike pregnancy, are not ‘all or none’.  A tear of a tendon in a shoulder can start small, and get bigger with time and activity.  A small tear may only lead to occasional pain.  As it gets bigger, there may be more a sense of weakness, limited range of motion, and increased pain.

Rotator cuff repair surgical procedure

The rotator cuff is repaired by using sutures to sew the torn ends of the tendon down to the bone of the humerus (arm bone).  Traditionally, this was done with a small 1 inch long incision made near the top of the shoulder where the deltoid muscle attaches.  With modern arthroscopic techniques, the same procedure can be done with small 4mm incisions around the shoulder.

The procedure is done with a general anesthetic.  Most of my patients also get a nerve block that helps to limit pain following the surgery for the first few days.

Through these small incisions, the entire shoulder joint is first carefully evaluated to determine if any other treatments are needed.  The personality of the tear is then determined.  The location on the bone  is established and this area is prepared by gently smoothing it.  Stitches are then placed into the torn tendon.  Each stitch is then used to put the torn end of the tendon back to its starting place.  The stitches are attached to bone by making small holes in the bone and holding the stitch in place with a small ‘suture anchor’.  

Rehabilitation after rotator cuff repair

Shoulder RehabilitationRehabilitation after rotator cuff repair starts right away.  The goal for the first 6 weeks is to decrease the inflammation and slowly regain range of motion.  It’s important not the let the shoulder get stiff after surgery but also take care of it such that the repair is not stressed too much causing the repair to fail.  Its a fine line.  A good physcial therapist will help guide the process. To get started both before and after surgery, see my set of passive range of motion exercises linked here:
Shoulder Passive Range of Motion Exercises
Guidelines for rehabilitation after surgery
Recovering after Rotator Cuff Repair
After six weeks, patients may start raising their arm and hand without assistance.  At week 12 (3 months out!) a light strengthening program will start.  It’s usually a five month to six month progress to return to full activities.  Each rehab program is tailored to the specifics of the patient so lets talk more about this.

Complications after rotator cuff repair

Complications after arthroscopic rotator cuff repair are rare.  These can include stiffness, weakness and failure of the repair.  More general surgical risks include blood clots, pulmonary embolus, infection and need for more surgery.  Always talk to me about your concerns and I will share with you my worries as well.  In general, keep in mind these risks are rare and that success is NOT rare !