Rotator Cuff Repair Surgery
Rotator cuff repair surgery aims to treat tears in the rotator cuff, which is a group of muscles and tendons that help move and stabilize your shoulder. If you're experiencing shoulder pain, weakness or difficulty performing daily activities due to a rotator cuff injury, this surgery may be a treatment option to help restore function and relieve pain.
What Is a Rotator Cuff Repair Surgery?
Rotator cuff tear surgery is a procedure to repair a torn tendon in the shoulder. The rotator cuff is a group of muscles and tendons that stabilizes your shoulder and allows it to move normally. Over time, due to injury, overuse or natural wear and tear, these tendons can become damaged or torn, leading to pain, weakness and difficulty with everyday activities like lifting your arm or getting dressed.
Before the surgery, your doctor will discuss your specific condition and treatment options. If surgery is the best option for you, you’ll receive instructions to prepare for the procedure. You may be asked to stop taking certain medications, such as blood thinners, and your doctor may advise you to stop smoking.
On the day of the surgery, you'll likely receive general anesthesia, which means you'll be asleep and won’t feel any pain. In some cases, regional anesthesia may be used to numb your shoulder and arm where the surgical site will be.
Rotator cuff repair surgery can be performed using one of the following three techniques. The choice of technique depends on the size and complexity of the tear, as well as the surgeon’s preference and other factors.
- Open repair: This is the traditional method and involves a larger incision in the shoulder. The surgeon moves the large shoulder muscle (deltoid) out of the way to reach the torn tendon. This approach is often used for large rotator cuff repairs.
- Arthroscopic shoulder surgery: In this minimally invasive approach, the surgeon makes small incisions in the shoulder and inserts an arthroscope, a small camera that allows the surgeon to view the inside of your shoulder on a monitor. Specialized tools are then used to repair shoulder muscle tear Arthroscopy is often performed on an outpatient basis, meaning you can go home the same day.
- Mini-open repair: This technique combines elements of both open repair and arthroscopy. The surgeon first uses arthroscopy to examine and treat any other issues in the shoulder, such as removing bone spurs. Then, through a small incision, the torn tendon is repaired.
During the surgery, the torn tendons are reattached to the bone. Small devices called suture anchors, which can be made of metal or dissolvable material, are often used to secure the tendon to the bone. Also, during any of these procedures, your surgeon may address additional shoulder problems, such as tears in other soft tissues, biceps tendon tears, or osteoarthritis. These issues can sometimes be treated during the same surgery to improve the overall function and comfort of your shoulder. Sutures (stitches) are then tied to keep everything in place. Once the repair is complete, the incisions are closed and a dressing is applied.
Each of these techniques has its own advantages and disadvantages, and your surgeon will recommend the best approach based on the size of your tear, the quality of the tendon tissue and bone, and your overall health. No matter which method is used, the ultimate goal is to get your shoulder functioning well and to relieve your pain.
How Quickly Should a Torn Rotator Cuff Be Repaired?
Deciding when to repair a torn rotator cuff can depend on several factors. Some tears may not require immediate surgery. In many cases, nonsurgical treatments such as physical therapy, rest and medications can effectively relieve pain and improve shoulder function.
However, there are certain situations where surgery might be recommended sooner rather than later:
- Persistent pain: If you've been dealing with pain for 6 to 12 months and it hasn't improved with nonsurgical treatments, your doctor may suggest that surgery could be the best option to relieve your discomfort.
- Large tears: If the tear in your rotator cuff is large (more than 3 cm) and the surrounding tendon tissue is in good condition, repairing the tear sooner rather than later may help prevent further damage.
- Significant weakness and loss of function: If you're experiencing noticeable weakness in your shoulder or difficulty performing everyday activities, surgery might be recommended to restore your shoulder's strength and function.
- Recent, acute injury: If your rotator cuff tear is the result of a recent injury, especially if it was caused by trauma like a fall or lifting something heavy, repairing it promptly can prevent the tear from worsening and improve the chances of a full recovery.
While there is no evidence that surgery performed immediately after an injury results in better outcomes compared to surgery done later, it's important to discuss your symptoms and situation with your doctor. Together, you can determine the best timing for your surgery based on your individual needs and lifestyle.
For most people, taking the time to try nonsurgical treatments first is often a good approach, as it avoids the risks and recovery time associated with surgery. However, if your symptoms persist or worsen, surgery may be necessary to get you back to your normal routine.
What Happens if Rotator Cuff Cannot Be Repaired?
If your rotator cuff tear cannot be repaired, it can be a frustrating and worrying situation. However, there are still options to help reduce your pain and improve your shoulder function. When a rotator cuff tear is too large or the tissue quality is poor, doctors may recommend alternative treatments to surgery. These treatments focus on relieving pain and restoring function.
One common option is physical therapy, which can strengthen the surrounding muscles and improve the range of motion in your shoulder. Although it may not completely restore your shoulder's function, physical therapy can help you manage your symptoms and regain some of your daily activities.
In some cases, doctors may also recommend non-surgical treatments like corticosteroid injections to reduce inflammation and pain. These injections can provide temporary relief, allowing you to participate more fully in physical therapy or manage your symptoms while continuing with daily activities.
If your shoulder is severely affected and non-surgical treatments do not provide enough relief, other surgical options may be considered. These include procedures like superior capsular reconstruction, which uses a graft to replace the damaged rotator cuff tissue or reverse total shoulder replacement, which czshanges the mechanics of your shoulder joint to help improve function despite the tear.
Your doctor will work with you to find the best solution that fits your individual needs and goals, helping you to get back to the activities you enjoy and maintain the best possible quality of life.
How Many Times Can a Rotator Cuff Be Repaired?
The number of times a rotator cuff can be repaired depends on several factors, including the quality of the tissue, the size of the tear and the patient's overall health. While it is possible to perform revision surgeries, each subsequent repair may become more challenging due to factors like poor tissue quality, scar tissue and adhesions from previous surgeries.
Surgeons carefully evaluate each case to determine whether another repair is feasible and likely to succeed. In some instances, additional surgical techniques, such as using biologic patches or bone marrow stimulation, may be employed to improve the chances of healing during revision surgeries.
It's important to note that revision surgeries are generally more complex than the initial repair. Your surgeon will discuss the potential benefits and risks with you, considering your specific situation and goals.