What is rotator cuff repair?

The rotator cuff is a network of muscles and tendons which stabilize the shoulder joint. It is one of the most important parts of the shoulder joint. It enables you to lift up your arm and reach upward. Tears or other forms of damage to the rotator cuff can occur suddenly from falling into your outstretched hand, or they can develop over time because of repetitive activities. Rotator cuff degeneration and tears also may be viewed as age-related.

If the rotator cuff is damaged, then you would need surgery to repair it. Bone spurs might be shaved away if they compress the shoulder or tears in the tendons or muscles of the shoulder that must be repaired. This often involves reattaching the tendon to the head of the humerus. It usually involves open surgery, or a combination of both, when arthroscopy is performed in the case of repair of an arthroscopic rotator cuff tear. The purpose of the surgery is to help restore the function and movement of the shoulder and also remove pain that cannot be managed by other treatments.

Why may a patient need the procedure?

Some of the causes that demand the repair of the rotator cuff include;

• Constant pain in the shoulder that persists at rest or even at night and has not responded to a specific exercise program (physical therapy) over a 3- to 4-month period.
• You are highly physical with the use or exertion of your shoulder for sports and working.
• You are feeble and weak and unable to perform simple daily tasks.
• Surgery is the best course if;
• You suffer a full-thickness rotator cuff tear
• Result from a tear caused by a trauma or an injury within the last several months.
• After receiving physiotherapy for some time, for several months, you do not change or get better.
• You experience extreme loss of function and symptoms.

A minor tear might not require surgery. Instead, rest and exercise become a cure for the shoulder. This is typically ideal for patients not heavily dependent on their shoulders for activities. Pain should be relieved. However, the tear can expand over time.

How does the rotator cuff repair procedure works?

A rotator cuff repair is conducted under general or regional anesthesia. If you choose general anesthesia, you will sleep right through the operation. Regional anesthesia puts your arm and shoulder to sleep, which can last as long as 16 hours. The arthroscope or an open, large, or small incision usually facilitates the surgery. The surgeon may employ a small camera to attach the tendon to the bone and then fix it with sutures or suture anchors. More significant tears may require a more traditional surgical technique and a longer incision. Calcium deposits or a bone spur may require open surgery, mini-open surgery, or even arthroscopy if it leads to pain and develops with the advancement of age. The incision is closed by sutures, and if it is arthroscopy, then pictures of the shoulder and repairs can be presented immediately after suturing to the dress.

What happens before surgery?

Inform your physician about the medicines you are taking, including any over-the-counter supplements or herbs.

Two weeks before surgery:

• You may be told to stop the use of blood thinners temporarily. Examples include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), and others
• Report drugs to continue their use on the day of surgery to your surgeon.
• If it's a medical condition, like diabetes or heart condition, your surgeon will request to meet your provider overseeing such treatment.
• Discuss your provider if you drink much alcohol, more than 1 or 2 drinks a day.
• Quit smoking if you do so. Ask your provider for assistance. Smoking can delay wound healing and bone healing.
• Let your surgeon know if you contract a cold, flu, fever, herpes outbreak, or other illness before the procedure. You may have to postpone your surgery.

What can I expect after the procedure?

Follow any discharge and aftercare instructions you receive.

You may end up leaving the hospital wearing a sling. Most patients wear a shoulder immobilizer, too. This will ensure that your shoulder remains as immobile as possible. The duration you'll need to wear the sling or immobilizer depends on your surgery type.

How much time it requires to recover?

Recovery is generally around 4 to 6 months minimum. Size of the tear and many other factors will govern this period. For example, you may be required to use a sling for at least 4 to 6 weeks after the surgery. Pain is usually managed with medication.

Physical therapy can restore much of your shoulder motion and strength. The amount of treatment you will have will depend on the repair that was done. You can expect to follow through with instructions for any shoulder exercises that you are sent to do.

What are the risks of a rotator cuff repair?

As with any surgery, complications can arise. Some possible complications may include:

• Bleeding
• Infection
• Blood clots in the legs or lungs
• Pain and weakness in the joint may persist after surgery. Your overall range of motion in the shoulder joint may not return.
• Tissue injury to the nerves or blood vessels of the surgical field may damage them, inducing a condition that may cause either weakness or numbness.

Other risks are specific to your underlying medical condition; ask your health-care provider about any of your concerns before surgery.

What is the success rate for rotator cuff repair surgery?

Rotator cuff surgery has a more than 95% success rate for small tears. Even with two tendon tears, the success rate is more than 70%. Unoperated tears tend to enlarge, so it is wise to repair them when they are small.

However, even with substantial tendon tears, patients can benefit from surgery. Sometimes, we employ a technique that is known as margin conversions. We put some grafted tissue over the humeral head that holds the tendon in the joint. If the tendon tissue is inadequate for direct repair, we place a patch of donor tissue in the area. Shoulders surgeons typically undertake a mini-open repair when tissue grafts are required instead of an arthroscopic repair.

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