Rotator Cuff Tear Surgery: Everything You Need to Know

Doctor preforming shoulder surgery
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A rotator cuff repair is a procedure in which torn tendons and/or muscles of the shoulder are surgically fixed. Rotator cuff tears can cause pain and weakness. Sometimes these tears can heal without surgery, but severe rotator cuff damage can be permanent without surgical intervention. Recovery after a rotator cuff repair operation requires weeks of restricted shoulder movement, followed by months of physical therapy exercises. It takes four to six months after surgery to fully heal and regain improved shoulder movement.

What Is Rotator Cuff Repair?

A rotator cuff repair is a surgical operation used to mend damaged or injured structures of the rotator cuff. The rotator cuff includes the tendons and muscles of the shoulder joint—also called the glenohumeral joint.

Sometimes rotator cuff repair also involves other steps, such as removal of bone spurs. Rotator cuff repair is usually an outpatient procedure that doesn't involve an overnight stay in the hospital. During your surgery, you would have pain control with general anesthesia, regional nerve block anesthesia, or both.

This repair can be done as an open procedure or a minimally invasive arthroscopic surgery.

You and your doctor will discuss the different options for your rotator cuff repair surgery, and the right surgical approach for you depends on the extent and exact location of your rotator cuff damage and the optimal means of accessibility for your repair.

Rotator cuff repair surgeries include:

  • Open surgical rotator cuff repair: An open procedure involves an incision that's between three to five inches long and a longer postoperative recovery than less invasive surgeries. This approach is used for better shoulder visualization or repair of extensive rotator cuff damage. You may also have a tendon transfer, in which a tendon is taken from your back to replace a torn tendon in your rotator cuff.
  • Arthroscopic rotator cuff repair: An arthroscopic rotator cuff repair is done through a small incision, less than an inch in length, and the insertion of a small surgical device equipped with a camera. The repair is done with surgical tools attached to the device as the camera transmits a live image of the inside of the rotator cuff to a monitor. The recovery is expected to be faster than recovery after an open repair.
  • Mini-open rotator cuff repair: The mini-open method includes an incision of approximately three inches and an arthroscopic portion of the surgery. During the arthroscopic step, your surgeon would remove damaged tissue or bone spurs and prepare your rotator cuff for repair. Once the arthroscopic portion is complete, the torn tendon is repaired. The recovery may be faster than recovery after an open cuff repair.
  • Shoulder replacement surgery: Large rotator cuff tears or multiple rotator cuff tears may be associated with degeneration or fractures of the neighboring cartilage or bone. These situations generally require shoulder replacement surgery and not just a rotator cuff repair. You might have a complete shoulder replacement, a partial shoulder replacement, or a reverse shoulder replacement.

Contraindications

A rotator cuff repair is not necessarily right for everyone who has a rotator cuff tear. Sometimes the tendon or muscles are so badly damaged that repair might not be possible.

Chronic illnesses, like cancer, may interfere with post-operative healing.

If you have an infection or if you are immunocompromised, you could be at risk of a post-operative infection, which might be a reason to delay your surgery.

While they are not strict contraindications, smoking and diabetes are associated with impaired healing.

Potential Risks

Rotator cuff surgery is usually safe and effective. There are some inherent risks of surgery and anesthesia. Additionally, rotator cuff repair surgery can cause specific problems and complications.

Post-surgical issues that can arise include:

  • Infection
  • Weakness due to nerve, muscle or tendon damage during surgery
  • Sensory changes
  • Increased pain
  • Stiffness or decreased mobility
  • Impaired healing

You would likely develop symptoms of pain, weakness, or swelling within a few weeks after surgery with these surgical complications.

Purpose of Rotator Cuff Repair

The main reason for this surgery is to improve symptoms caused by a rotator cuff tear—which are typically pain and diminished mobility. A rotator cuff tear can involve one or more muscles or tendons, and you can have a partial or complete tear.

This type of damage may occur due to repetitive motion or sudden injury. Even with repetitive damage, a rotator cuff tear can slowly worsen or may occur abruptly.

Symptoms of rotator cuff tear include:

  • Shoulder pain at rest
  • Pain when lifting or lowering your arm
  • Decreased range of shoulder motion
  • Weakness of your shoulder
  • A cracking sensation with shoulder movement

Your doctor will do a physical examination to evaluate these symptoms. Your evaluation will include an assessment of your strength, sensation, and areas of tenderness. You may also have diagnostic tests, such as an X-ray or magnetic resonance imaging (MRI) test.

Your tendons and/or muscles can be partially frayed, frail, or completely ripped. You might also have degeneration of cartilage, bone fractures, or bone spurs.

Treatment often starts with conservative therapy and may include rest, physical therapy, and oral or injected anti-inflammatory medication. Small tears in your rotator cuff can heal. If your symptoms don't improve with non-surgical management or if your injury is so severe that it isn't likely to heal without an operation, your doctor will discuss the surgical options with you.

How to Prepare

Prior to your surgery, your surgeon will obtain imaging tests to plan your procedure. This can include different views of your joint. You will also have preoperative tests to prepare for anesthesia, including an electrocardiogram (EKG), chest X-ray, complete blood count (CBC), and blood chemistry panel.

You and your doctor will discuss the recovery process, the type of surgery that is best for you, and the location and size of your incision.

Location

Your surgery will be done in an operating room that can be located in a hospital or a surgical center. A rotator cuff repair is an outpatient procedure, so you will come to your appointment from home and go home on the same day.

What to Wear

You can wear anything comfortable to your surgery appointment. You will need to change into a hospital gown for your procedure.

Since you will have your shoulder wrapped and in a sling after surgery, you should bring loose clothes that you can slip over your surgical dressing to wear on your way home.

Food and Drink

You should abstain from eating and drinking after midnight the night before your scheduled surgery.

Medications

Your doctor might ask you to stop or adjust some of your regular prescriptions for several days prior to your surgery if you take blood thinners or anti-inflammatory medications.

What to Bring

When you go to your surgery appointment, you need to bring your identification, insurance information, and a form of payment if you are expected to pay for a portion of the cost of your surgery.

You won't be able to drive yourself home, so you need to have someone with you who can drive you home on the day of your surgery.

Pre-Op Lifestyle Changes

Your doctor may instruct you to rest your arm for several weeks before your surgery, especially if your injury has been caused by repetitive movements, such as lifting.

What to Expect on the Day of Surgery

When you go to your surgical appointment, you will need to sign in and fill out a consent form. You might have same day pre-operative tests, including a CBC, blood chemistry, urine test, and a chest X-ray.

You will go to a pre-surgical area, where you will change into a hospital gown. You will have your temperature, pulse, blood pressure, respiratory rate, and oxygen level checked. A nurse will place an intravenous (IV, in a vein) line in your hand or arm for the administration of your anesthesia medication.

Your doctor may examine your shoulder and your movement on the day of surgery to determine whether you have had any changes since your most recent physical examination. You will be taken to the operating room to have your surgery.

Before the Surgery

Before your surgery is started, you will have your surgical site prepped and your anesthesia will be started.

Your surgical team will place a drape over you, exposing the area where your doctor will place your incision. Your skin will be cleansed to reduce the chances of an infection.

You will also have anesthetic medication injected into your IV to make you sleepy. You will likely also have regional anesthesia, with anesthetic medication placed near a spinal nerve to prevent you from feeling pain during surgery.

Regional anesthesia for rotator cuff repair is generally placed for an interscalene brachial plexus block. You may have the anesthetic medication injected with a needle that is immediately removed, or your anesthesiologist may leave a catheter in place during your surgery for continued injection of pain medication.

You may also have general anesthesia during your surgery, with medication injected into your IV to make you fall asleep and prevent you from moving or having sensation. If you have general anesthesia, your anesthesiologist will place a tube in your throat so you will have mechanical assistance with your breathing.

During the Surgery

Your surgery will begin after your anesthesia is started. Because there are several different procedures used for rotator cuff repair, the size of your incision will depend on the type of surgery you are having.

Your surgeon will make an incision on your shoulder. A small arthroscope will be placed if you are having an arthroscopic procedure. And if you are having an open surgery, your doctor will make an incision to visualize and access your rotator cuff without the assistance of a camera.

You may need to have removal of bone spurs or damaged tissue. Your doctor may need to cut connective tissue or muscle in order to reach a torn ligament or muscle of your rotator cuff. Typically, the deltoid muscle is cut during an open or mini-open rotator cuff repair, but muscle does not need to be cut for an arthroscopic rotator cuff repair.

The damaged area will be repaired with sutures or a torn ligament may be attached to the corresponding bone with metal surgical anchors or with anchors that will dissolve over time.

If you are having a tendon transfer, a tendon will be taken from another area of your body, typically from the latissimus dorsi in your back, and surgically positioned in place of your torn rotator cuff tendon.

After repair of your torn structures, your surgeon will mend any tissue that was cut for surgical access. Your skin will be closed with sutures, and bandages will be placed on the surgical wound.

When your surgery is complete, your anesthesia will be stopped or reversed, and your breathing tube will be removed. Your anesthesia team will ensure that you are stable and breathing comfortably on your own before you are taken to a postoperative recovery area.

You may have your arm placed in a sling in the operating room or when you get to the postoperative recovery area.

After the Surgery

As you are waking up after surgery, your medical team will continue to monitor your breathing, pulse, blood pressure, and oxygen. You will receive pain treatment as needed.

You will be given instructions regarding wound care, activity, pain control, and when and how to restart any medications that you were asked to adjust prior to your surgery.

Your doctor will likely examine you to ensure that things are going as planned. And if you are not having any complications, you should be discharged to go home a few hours after your surgery. You will need someone to drive you home.

Recovery

It will take four to six weeks for your wound to heal after your rotator cuff surgery, and four to six months for full recovery after the procedure. During this time, your doctor will let you know when to stop using your arm sling.

Generally, the more extensive and open your surgery, the longer it will take you to heal and recover. Shorter recovery time is associated with arthroscopic rotator cuff repair.

Throughout your healing and recovery period, you will see your doctor for follow up appointments, and your doctor will examine your shoulder and range of motion and remove your sutures.

Your healing and recovery process includes care of your surgical wound and your shoulder to avoid postsurgical complications, as well as a gradual increase in activity so you can optimize your shoulder strength and motion.

Healing

As you are healing, you may need to take pain medication, and you should be sure to call your doctor if you are experiencing severe or worsening pain.

Warning signs of complications include:

  • Fever
  • Severe pain
  • Worsening pain
  • Bleeding or pus oozing from the wound or dressing
  • Redness around your shoulder
  • Tenderness
  • Swelling
  • Inability to advance your shoulder movements as directed

Call your doctor's office if you experience any of these issues.

Throughout the healing process, you need to be sure to keep your dressing and your wound clean and dry and to care for it according to the instructions that you were given upon discharge.

Coping With Recovery

As you are recovering, you will have your arm in a sling for several weeks. You might be instructed to limit movements of your surgical shoulder for the first week if you've had an arthroscopic procedure, and possibly for several weeks after an open procedure. This can affect your ability to do things like drive, self-care, and work.

You will be instructed to increase your level of activity gradually so you can strengthen your shoulder and arm. You will also need to go to supervised rehabilitation and physical therapy. At your sessions, you will participate in active and passive movements to strengthen your shoulder and to prevent it from getting stiff.

Long-Term Care

After you have fully healed, you should be able to move your arm with an improved range of motion and without pain. It is important that you stay active to avoid stiffness of your arm.

Possible Future Surgeries

Typically, a rotator cuff repair surgery is a one-time procedure without a plan for follow up procedures or additional surgical steps.

However, if your rotator cuff tear was caused by a medical condition, like bone spurs or arthritis, you can experience another injury or further damage if the condition isn't properly treated.

And a recurrent tear can develop years after a repair. Generally, more extensive presurgical damage is more likely than less severe presurgical damage to result in a repeat injury after a rotator cuff repair.

Lifestyle Adjustments

After having a rotator cuff repair surgery, you should not continue any activity or repetitive movements that could cause another injury. While it is important to stay active, you need to make sure that you avoid future damage. Talk to your doctor and physical therapist about modifications you may need to take at work or in sports to prevent further injuries.

A Word From Verywell

A rotator cuff repair surgery can improve your quality of life if you have pain or limited range of motion due to a rotator cuff tear. There are several surgical methods used for this type of repair, and the right one for you depends on the extent and location of your injury. If you decide to go ahead with a rotator cuff repair surgery, you will have a rehabilitation period with limitations of your arm movement, followed by gradually increasing arm movement and physical therapy before you reach full recovery.

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