Rotator cuff disorders come in a variety of degrees and the complexity of the tear usually dictates the repair approach:
- Smaller, less complicated tears are fixed arthroscopically. In this minimally invasive approach, the surgeon makes several small incisions around the shoulder joint and inserts a narrow fiber optic scope (called an arthroscope) to examine the condition of the rotator cuff. Tiny instruments are used to remove loose debris, sew the torn edges of the tendon together and attach it to the humerus (upper arm bone). This minimally invasive approach offers numerous benefits including less muscle and tissue trauma, less bleeding, less pain and a much faster recovery. Patients usually go home the same day.
- Traditional open surgery may be necessary for larger, more challenging rotator cuff tears. The surgeon opens the shoulder with a three- to five-inch incision and looks directly at the torn tendon while repairing it. Open shoulder surgery often requires a short hospital stay, and recovery can be longer and more painful.
Anatomy
The rotator cuff is a group of tendons and muscles in the shoulder connecting the humerus to the scapula (shoulder blade). Rotator cuff tendons help stabilize the shoulder joint and rotator cuff muscles help you raise and rotate your arm.
There are two different types of rotator cuff tears. A partial tear damages the soft tissue, but does not completely sever it. A complete tear, also called a full-thickness tear, splits the soft tissue into two pieces. In many cases, the tendons tear off where they attach to the head of the humerus.
When is surgery recommended?
Surgery is used to treat a rotator cuff tear if the injury is very severe, or if nonsurgical treatment—rest, physical therapy, non-steroidal anti-inflammatory drugs (NSAIDs) and cortisone injections—has failed to improve strength and movement. It’s also a good option for patients who are highly motivated to return to a very active lifestyle.
In younger and middle-aged patients, surgery is the treatment of choice for a full-thickness tear if the tendon is repairable. Partial tears often respond to conservative treatment and heal without surgery. For older patients with natural degeneration, the decision to have surgery is based on a number of factors including symptoms, function, repairability and tissue quality.
What is the recovery time?
Following rotator cuff surgery, proper rehabilitation is key to a successful outcome. Recovery can be a lengthy, challenging process. It begins with four to six weeks of immobilization in a sling, followed by a month of passive physical therapy to regain range of motion in the arm, and several months of active therapy to improve strength and control.