Surgical Rotator Cuff Repair

Rheumatoid Arthritis

Overview

Surgery to repair a torn rotator cuff typically involves re-attaching the tendon(s) to the head of the humerus bone. The goal of the surgery is to relieve pain and improve shoulder function. The type of surgery recommended depends on the extent and location of the tear, as well as the patient’s overall health and activity level.

Surgery for a torn rotator cuff is usually considered when nonsurgical treatments have not been effective in relieving pain. Persistent pain is the main reason for surgery to be offered. In addition, if you are very active and engage in activities that require overhead arm movements or sports, your doctor may suggest surgery.

Other signs that surgery may be a good option for you include:

  • If you have been experiencing symptoms for 6 to 12 months
  • If your tear is larger than 3 cm and the tendon tissue surrounding the tear is of good quality
  • If you have significant weakness and loss of function in your shoulder
  • If your tear was caused by a recent, acute injury

It’s important to note that the decision to undergo surgery should be made jointly by you and your doctor, taking into consideration your overall health, activity level, and the severity of your symptoms.

There are two main types of rotator cuff repair surgery: arthroscopic and open. Arthroscopic surgery involves making small incisions in the shoulder and using a camera and specialized tools to repair the tear. This type of surgery is less invasive and usually results in a faster recovery time. Open surgery involves making a larger incision to directly access the shoulder joint and repair the tear.

Diseases treated with the Surgical Rotator Cuff Repair

A surgery for rotator cuff tears can treat a variety of conditions related to rotator cuff tears, including:

  • Partial or complete rotator cuff tears
  • Tendinitis or tendinosis
  • Subacromial impingement syndrome
  • Bursitis
  • Calcific tendonitis
  • Shoulder instability
  • Shoulder arthritis

However, the decision to undergo surgery is based on the specific individual case, including the patient’s age, general health, activity level, severity of symptoms, and the type and size of the tear. It is important to discuss the risks, benefits, and alternative treatments with a doctor before making a decision about surgery.

Types of Surgical Rotator Cuff Repair

There are several options available for repairing rotator cuff tears, and the type of repair performed depends on various factors, such as tear size, anatomy, and the quality of tendon tissue and bone. The three techniques most commonly used for rotator cuff repair are traditional open repair, arthroscopic repair, and mini-open repair.

  • Open repair, arthroscopic repair, and mini-open repair are the three most commonly used techniques for rotator cuff repair. Open repair is often required for large or complex tears, and it involves making a several centimeters long incision over the shoulder to detach or split part of the deltoid muscle to gain better access to the torn tendon.
  • Arthroscopic repair, on the other hand, involves inserting a small camera, called an arthroscope, into the shoulder joint through small incisions and using miniature surgical instruments to repair the tear. This method is less invasive than open repair and is usually an outpatient procedure.
  • Mini-open repair is a combination of open and arthroscopic repair, where a smaller open incision is made to repair the tendon after assessing and treating damage to other structures within the joint using arthroscopy.

Your surgeon will determine the best technique based on several factors, including the size of the tear, your anatomy, and the quality of the tendon tissue and bone.

Preparation for Surgical Rotator Cuff Repair

To prepare for rotator cuff repair surgery, here are some general steps that you can take:

  • Follow your doctor’s instructions: Before the surgery, your doctor will give you specific instructions to follow. These may include dietary restrictions, medications to avoid, and other important information. Make sure to follow these instructions carefully.
  • Arrange for help: You may need help from family or friends after the surgery. Plan ahead and arrange for someone to assist you with daily activities such as cooking, cleaning, and transportation.
  • Stop smoking: Smoking can increase the risk of complications during and after surgery. If you smoke, try to quit or at least cut back before the surgery.
  • Get in shape: The better shape you are in before the surgery, the easier it will be to recover. Talk to your doctor about exercises you can do to strengthen your shoulder and improve your overall fitness.
  • Stock up on supplies: You will need some supplies after the surgery, such as ice packs, bandages, and pain medication. Make sure you have these items on hand before the surgery.
  • Arrange for time off: You will need to take time off work to recover from the surgery. Talk to your employer and make arrangements for time off and any necessary accommodations.
  • Follow a healthy diet: Eating a healthy diet before the surgery can help improve your overall health and speed up recovery. Eat plenty of fruits, vegetables, lean proteins, and whole grains.
  • Make sure to talk to your doctor about any specific steps you need to take to prepare for the surgery.

Surgical Rotator Cuff Repair Procedure

During the surgery, the surgeon may also be able to address any other shoulder problems, such as biceps tendon tears, osteoarthritis, bone spurs, or other soft tissue tears. Most surgical repairs can be done on an outpatient basis, and the patient’s orthopedic surgeon will discuss with them the best procedure to meet their individual health needs. Patients typically rate all three repair methods similarly for pain relief, strength improvement, and overall satisfaction.

Here are the general steps involved in a rotator cuff repair surgery:

  • Anesthesia: Before the surgery begins, the patient will receive anesthesia. This can be general anesthesia, which puts the patient to sleep, or regional anesthesia, which numbs the arm and shoulder while the patient remains awake.
  • Incision: Once the anesthesia has taken effect, the surgeon will make one or more incisions in the shoulder area. The size and location of the incision will depend on the type of surgery being performed.
  • Arthroscopy (if applicable): If an arthroscopic repair is being done, the surgeon will insert a small camera called an arthroscope into the incision to get a clear view of the inside of the shoulder joint.
  • Tendon repair: The surgeon will then locate the torn tendon and reattach it to the bone. This can be done in a number of ways depending on the specific technique being used, such as with sutures or anchors.
  • Closure: Once the tendon has been repaired, the surgeon will close the incision(s) with sutures or staples and cover the area with bandages and a sling.
  • Recovery: The patient will be taken to a recovery area to wake up from anesthesia and be monitored for any complications. After a short period of observation, the patient can usually go home the same day. Physical therapy and rehabilitation will be necessary to regain strength and mobility in the shoulder over several weeks or months.

It’s important to note that the specific steps involved in a rotator cuff repair surgery can vary depending on the individual patient, the type and extent of the tear, and the surgeon’s preferred techniques. Your orthopedic surgeon can provide you with more detailed information about what to expect from your specific procedure.

Benefits of Surgical Rotator Cuff Repair

The benefits of rotator cuff repair surgery depend on the individual patient’s condition and the extent of their injury. However, some general benefits of rotator cuff repair surgery include:

  • Pain relief: One of the primary benefits of rotator cuff repair surgery is a reduction in shoulder pain. The surgery can address the underlying cause of the pain and discomfort associated with rotator cuff tears, allowing patients to resume their normal activities without discomfort.
  • Improved range of motion: Rotator cuff repair surgery can help to restore the range of motion in the shoulder joint. This can help patients regain mobility and function in the affected shoulder.
  • Improved strength: Rotator cuff tears can cause weakness in the shoulder, making it difficult to perform everyday tasks and participate in physical activities. Surgery can help to restore strength to the shoulder, allowing patients to resume their normal activities.
  • Prevent further damage: Without treatment, rotator cuff tears can worsen over time and lead to additional damage to the shoulder joint. Rotator cuff repair surgery can prevent further damage and help to protect the shoulder joint from additional wear and tear.
  • Improved quality of life: By addressing the underlying cause of pain and discomfort, restoring range of motion and strength, and preventing further damage to the shoulder joint, rotator cuff repair surgery can improve a patient’s overall quality of life.