Rotator Cuff Repair

(Rotator Cuff Surgery, Shoulder Surgery)

This article is also available as a podcast, listen here.

Procedure Overview

What is rotator cuff repair?

The rotator cuff consists of muscles and tendons that hold the shoulder in place. It is one of the most important parts of the shoulder. The rotator cuff allows a person to lift his/her arm and reach up. An injury to the rotator cuff, such as a tear, may happen suddenly when falling on an outstretched hand or develop over time due to repetitive activities. Rotator cuff degeneration and tears may also be caused by aging.

If the rotator cuff is injured, it may need to be repaired surgically. This may include shaving off bone spurs that are pinching the shoulder, or repairing torn tendons or muscles in the shoulder. Surgical techniques that may be used to repair a tear of the rotator cuff include arthroscopy, open surgery, or a combination of both. The goal of rotator cuff repair surgery is to help restore the function and flexibility of the shoulder and to relieve the pain that cannot be controlled by other treatments.

Other related procedures that may be used to help diagnose shoulder disorders include x-ray, magnetic resonance imaging (MRI), computed tomography (CT scan), arthroscopy, arthrography, and ultrasound. Please see these procedures for additional information.

Anatomy of the shoulder:

click image to enlarge

The shoulder is made up of several components, including the following:

• bones - the collarbone (clavicle), the shoulder blade (scapula), and the upper arm bone (humerus).
  
  
• joints - facilitate movement, including the acromioclavicular (AC) joint (where the clavicle meets the acromion) and the shoulder joint (glenohumeral joint) that facilitates forward, circular, and backward movement of the shoulder.
  
  
• ligament - a type of tough, elastic connective tissue that surrounds the joint to give support and limits the joint's movement. The ligaments of the shoulder include the joint capsule (a group of ligaments that connect the humerus to the socket of the shoulder joint on the scapula to stabilize the shoulder and keep it from dislocating), ligaments that attach the clavicle to the acromion, and ligaments that connect the clavicle to the scapula by attaching to the coracoid process.
  
  
• acromion - the roof (highest point) of the shoulder that is formed by a part of the scapula.
  
  
• tendon - a type of tough connective tissue that connects muscles to bones and helps to control movement of the joint.
  
  
• muscle - a strong, contractile tissue that helps support and rotate the shoulder in many directions.
  
  
• rotator cuff - composed of tendons, the rotator cuff (and associated muscles) holds the ball of the glenohumeral joint at the top of the upper arm bone (humerus).
  
  
• bursa - a fluid-filled sac located between bones, ligaments, or other adjacent structures that helps cushion joints. In the shoulder, the bursa is located between the rotator cuff muscle layer and the outer layer of large, bulky muscles and keeps the rotator cuff from rubbing on the shoulder joint.

Reasons for the Procedure

Injuries to the shoulder are common. Athletes and construction workers often have rotator cuff injuries due to repetitive movement and overuse of the shoulder. The rotator cuff may be damaged from a fall or other injury to the shoulder. Damage may also occur slowly over time. The damage may be due to:

• strain or tears in the rotator cuff.
  
  
• inflammation of the bursa (bursitis) in the shoulder.
  
  
• inflammation of the tendons (tendonitis) in the shoulder.
  
  
• impingement syndrome - caused by the excessive squeezing or rubbing of the rotator cuff and shoulder blade. The pain associated with the syndrome is a result of an inflamed bursa over the rotator cuff, and/or inflammation of the rotator cuff tendons, and/or calcium deposits in tendons due to wear and tear. Shoulder impingement syndrome may lead to a torn rotator cuff.

Recurrent pain, limited ability to move the arm, and muscle weakness are the most common symptoms.

If medical treatments are not satisfactory, rotator cuff repair surgery may be an effective treatment. Medical treatments for rotator cuff injury may include, but are not limited to, the following:

• rest
  
  
• nonsteroidal anti-inflammatory medications
  
  
• strengthening and stretching exercises
  
  
• ultrasound therapy
  
  
• steroid injections

Rotator cuff surgery may be performed using an arthroscope. An arthroscope is a small tube-shaped instrument that is inserted into a joint. It consists of a system of lenses, a small video camera, and a light for viewing. The camera is connected to a monitoring system that allows the physician to view a joint through a very small incision. The arthroscope is often used in conjunction with other tools that are inserted through another incision.

An open repair may be performed if the rotator cuff injury cannot be repaired using arthroscopy. In some cases, a tendon graft and joint replacement may be necessary.

There may be other reasons for your physician to recommend rotator cuff repair.

Risks of the Procedure

As with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to, the following:

• bleeding
  
  
• infection
  
  
• blood clots in the legs or lungs

The joint pain may not be relieved by the surgery. You may not recover full range of motion in the shoulder joint.

Nerves or blood vessels in the area of surgery may be injured, resulting in weakness or numbness.

There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

Before the Procedure

• Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
  
  
• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
  
  
• In addition to a complete medical history, your physician may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
  
  
• Notify your physician if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
  
  
• Notify your physician of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
  
  
• Notify your physician if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
  
  
• If you are pregnant or suspect that you are pregnant, you should notify your physician.
  
  
• You will be asked to fast for eight hours before the procedure, generally after midnight.
  
  
• You may receive a sedative prior to the procedure to help you relax. Because the sedative may make you drowsy, you will need to arrange for someone to drive you home.
  
  
• You may meet with a physical therapist prior to your surgery to discuss rehabilitation.
  
  
• Based upon your medical condition, your physician may request other specific preparation.

During the Procedure

Rotator cuff repair may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your physician’s practices.

Rotator cuff repair may be performed while you are asleep under general anesthesia. Your physician will discuss this with you in advance.

Generally, rotator cuff repair surgery follows this process:

1. You will be asked to remove clothing and will be given a gown to wear.
   
   
2. An intravenous (IV) line may be started in your arm or hand.
   
   
3. You will be positioned on the operating table.
   
   
4. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
   
   
5. The skin over the surgical site will be cleansed with an antiseptic solution.
   
   
6. The physician will make an incision in the shoulder area. The incision will vary depending upon the type of surgery (open surgery, arthroscopy, or a combination of both) that may be performed.
   
   
7. The arthroscope (if used) will be inserted through the incision.
   
   
8. Other incisions may be made to introduce other small grasping, probing, or cutting tools.
   
   
9. Injured tendons and muscles will be repaired or replaced with a graft tendon from another part of the body.
   
   
10. Bone spurs (if present) will be removed.
    
    
11. The incision will be closed with stitches or surgical staples.
    
    
12. A sterile bandage/dressing will be applied.

After the Procedure

After surgery, you will be taken to the recovery room for observation. Your recovery process will vary depending upon the type of anesthesia that is given and the type of surgery that is performed. The circulation and sensation of the arm will be monitored. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to your home.

You may be given an immobilizer or sling before you go home.

Once you are home, it is important to keep the surgical area clean and dry. Your physician will give you specific bathing instructions. The stitches or surgical staples will be removed during a follow-up office visit.

Take a pain reliever for soreness as recommended by your physician. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

To help reduce swelling, you may be asked to apply an ice bag to the shoulder several times per day for the first few days. You should keep the sling or immobilizer on as directed by your physician.

Your physician will arrange for an exercise program to help you regain muscle strength, flexibility, and function of your shoulder.

Notify your physician to report any of the following:

• fever
  
  
• redness, swelling, bleeding, or other drainage from the incision site
  
  
• increased pain around the incision site
  
  
• numbness or tingling in the affected arm or hand

You may resume your normal diet unless your physician advises you differently.

You should not drive until your physician tells you to. Other activity restrictions may apply. Full recovery from the surgery may take several months.

Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.

Online Resources

The content provided here is for informational purposes only, and was not designed to diagnose or treat a health problem or disease, or replace the professional medical advice you receive from your physician. Please consult your physician with any questions or concerns you may have regarding your condition.

This page contains links to other Web sites with information about this procedure and related health conditions. We hope you find these sites helpful, but please remember we do not control or endorse the information presented on these Web sites, nor do these sites endorse the information contained here.

American Academy of Orthopaedic Surgeons

American College of Rheumatology

Arthritis Foundation

National Institute of Arthritis and Musculoskeletal and Skin Diseases

National Institutes of Health (NIH)

National Library of Medicine