Are you headed for
Rotator Cuff Surgery?
Have you been told you need rotator cuff surgery? Does a torn rotator cuff always mean surgery is necessary? What does surgery and rehabilitation involve? The more you know the better prepared you will be to undergo this procedure and ensure a more positive outcome.
What is Rotator Cuff Surgery?
The rotator cuff is a group of four tendons: infraspinatus, supraspinatus, teres major, and subscapularis. These tendons function to help stabilize and assist with shoulder movement. Injury to any one of these tendons can result in pain and limited range of motion. When the rotator cuff tears, the most common tendon injured is the supraspinatus.
With a significant tear, surgery is necessary to repair the torn tendon. Surgery is required because the ends of the tendon are unable to reconnect and heal. The repair is done by suturing the ends of the tendon back together.
How does the Rotator Cuff tear?
Trauma, both acute and repetitive is the most common cause of a
torn rotator cuff.
Trauma can include a fall on an outstretched arm, lifting something heavy overhead, or doing an overhead throw. Repetitive trauma can also cause tearing of the rotator cuff. Bone spurs in the shoulder can narrow the space in which the supraspinatus sits. Repetitive overhead motion can allow these bone spurs to push into the rotator cuff creating tears over time.
Who needs Rotator Cuff Surgery?
Surgery to repair the rotator cuff is necessary in two instances. First, the tear is so significant and range of motion so limited that conservative care will not be successful. This diagnosis is generally made via an MRI with or without contrast. Second, conservative treatment has been attempted (generally up to 12 weeks) but pain and limited shoulder mobility continues. Typical conservative treatment can include
ice therapy,
physical therapy, anti-inflammatory medications, and cortisone injections.
What does Rotator Cuff Surgery involve?
Surgery to repair the rotator cuff is generally performed via an arthroscopic procedure. This procedure utilizes small incisions to allow for visualization and repair of the tendon. Sutures are utilized to repair the tendon, often securing the end of the torn tendon directly into the humerus. The benefit to this surgery is that smaller incisions will result in less pain and generally more mobility immediately following surgery. The limitation is that it is a technically more difficult surgery, especially for larger tendon tears.
Click here to view an anamation of an arthroscopic rotator cuff repair.
An open repair is generally only performed when the tear is too great to allow for the arthroscopic repair. A large incision is made along the outside of the shoulder in order for the surgeon to visualize and repair the tear. Although this surgery involves generally greater pain and more shoulder stiffness initially after surgery, this procedure may be necessary to get a solid repair of larger tendon injuries. Open procedures have become much less common as surgeons have improved their arthroscopic techniques when dealing with large rotator cuff tears.
In addition to repairing the tendon itself, another procedure called an acromioplasty may also be performed. If the tendon tear was in part due to bone spurs or an acromial hook pushing into the tendon, removal of these bone spurs or hook will be necessary in order to minimize the risk of further tendon injuries. Rotator cuff surgery is generally performed on an outpatient basis. A stay in the hospital may be necessary if an open procedure is being performed or you have other health related conditions that warrant observation after surgery. Following surgery you will be required to wear a sling. Often the sling will have a small pillow attached. The purpose of this pillow is to position the arm slightly away from the body. This position allows for greater blood flow to the healing tendon.
As part of the post operative care, controlling pain will be important. Utilize pain medications as indicated by your physician. Sleeping can specifically be challenging as pressure on the shoulder may create pain or discomfort. Many find that sleeping upright in a recliner helpful during the first nights after recovery. Utilizing
ice therapy
on a consistent basis will also be helpful in reducing both pain and post operative swelling. Ice the shoulder 10 to 20 minutes at a time, frequently throughout the day.
Physical Therapy
Every physician will have his or her own physical therapy protocol for their rotator cuff repairs. The typical progression includes increasing passive range of motion, active range of motion, strength, and finally return to function or sports.Most often physical therapy will begin within the first few weeks after surgery. During the first six weeks following surgery, active movement will not be allowed. Therapy will focus on manual stretching by the physical therapist. Capsulitis or
frozen shoulder
is a potential complication following surgery thus restoring normal range of motion will be the emphasis during this initial phase. Beginning six weeks post op, active motion is the shoulder is allowed. The extent to which your physical therapy program will incorporate active motion exercises will be determined by how much range of motion you have when the physical therapist moves the arm. Light isometirc strengthening exercises will be added as active mobility increases. Strengthening exercises of the scapula muscles will also be initiated. By twelve weeks post op strengthening exercises of the rotator cuff itself will be utilized. As strength improves progression toward overhead activity such as throwing will be allowed. Return to overhead throwing activity can take six months. Unfortunately, the progression of the rehabilitation process can be at times slow and painful. The extent of the tear, age of the person, hand dominance, and complications such as post operative stiffness can all impact progress. Many indicate that the repaired shoulder does not feel “completely normal” until up to nine months after surgery.
Summary
• Rotator cuff surgery is generally recommended with significant tendon tears and when conservative treatment has failed.• Arthroscopic surgery is the most common procedure with surgery generally being an outpatient procedure. • Utilizing ice, the sling, and pain medication will all be important as part of the initial post operative care. • Physical therapy will most often begin within a few weeks after surgery with active motion restricted for six weeks and strengthening beginning after twelve weeks. Rotator cuff surgery is a significant procedure. Discuss all options and expectations with your surgeon before the big day. Knowing what to expect will help ensure the best outcome possible.
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