Rotator Cuff Repair
What is a rotator cuff repair?
The rotator cuff consists of muscles and tendons that hold the shoulder in place. It’s one of the most important parts of the shoulder. It allows you to lift your 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 your rotator cuff is injured, you may need to repair it surgically. This may include shaving off bone spurs that are pinching the shoulder, or repairing torn tendons or muscles in the shoulder. This usually involves reattaching the tendon to the head of the humerus. 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 can’t be controlled by other treatments.
Why might I need a rotator cuff repair?
Shoulder injuries 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 happen slowly over time. The damage may be due to:
- Strains or tears in the rotator cuff.
- Inflammation of the bursa (bursitis) in the shoulder.
- Inflammation of the tendons (tendinitis) in the shoulder.
Recurrent pain, limited ability to move the arm, and muscle weakness are the most common symptoms.
If medical treatments aren't working, rotator cuff repair surgery may be an effective treatment. Medical treatments for rotator cuff injury may include the following:
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Strengthening and stretching exercises
- Steroid injections
Rotator cuff surgery may be done 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 surgeon to view a joint through a very small incision. The arthroscope is often used along with other tools that are inserted through another small incision.
An open repair may be done if the rotator cuff injury can’t be repaired using arthroscopy. In some cases, a tendon graft or joint replacement may be needed.
There may be other reasons for your healthcare provider to recommend rotator cuff repair.
How do I get ready for a rotator cuff repair?
- Your healthcare provider will explain the procedure to you and offer you the chance 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 healthcare provider may do a complete physical exam to make sure that you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
- Tell your healthcare provider if you are sensitive to or are allergic to any medicines, latex, tape, and anesthetic agents (local and general).
- Tell your healthcare provider of all medicines (prescribed and over-the-counter) and herbal supplements that you are taking.
- Tell your healthcare provider if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medicines, aspirin, or other medicines that affect blood clotting. It may be necessary for you to stop these medicines before the procedure.
- If you are pregnant or suspect that you are pregnant, tell your healthcare provider.
- You will be asked to fast for 8 hours before the procedure, generally after midnight.
- You may get a sedative before 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 before your surgery to discuss rehabilitation.
- Based on your medical condition, your healthcare provider may request other specific preparation.
What happens during a rotator cuff repair?
Rotator cuff repair may be done on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your healthcare provider’s practices.
Rotator cuff repair may be done while you are asleep under general anesthesia, or while you are awake under local or regional anesthesia. If regional anesthesia is used, you will have no feeling in your shoulder. The type of anesthesia will depend on the specific procedure being done. Your healthcare provider will discuss this with you in advance.
Generally, rotator cuff repair surgery follows this process:
- You will be asked to remove clothing and will be given a gown to wear.
- An IV (intravenous) line may be started in your arm or hand.
- You will be positioned on the operating table.
- The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
- The skin over your surgical site will be cleaned with an antiseptic solution.
- Your healthcare provider will make a cut (incision) in the shoulder area. The incision will vary depending on the type of surgery (open surgery, arthroscopy, or a combination of both) that may be done.
- The arthroscope (if used) will be put through the incision.
- Other incisions may be made to use other small grasping, probing, or cutting tools.
- The provider will fix or replace injured tendons and muscles with a graft tendon from another part of the body.
- Bone spurs will be removed if they are present.
- The incision will be closed with stitches or surgical staples.
- A sterile bandage or dressing will be applied.