Rotator Cuff Repair

Why the Procedure Is Performed

Reasons rotator cuff repair may be done include:

• You have shoulder pain when you rest or at night, and it has not improved with exercises over 6 to 12 months.
• You are active and use your shoulder for sports or work.
• You have weakness and are unable to do everyday activities.

Surgery is a good choice when:

• You have a large or a complete rotator cuff tear.
• A tear was caused by a recent injury.
• The tendons of the rotator cuff were not already torn from chronic rotator cuff problems.

A partial tear may not require surgery. Instead, rest and exercise are used to heal the shoulder. This approach is often best for people who do not place a lot of demand on their shoulder. Pain can be expected to improve. The tear may become larger over time.

Risks

Risks of anesthesia and surgery in general are:

• Allergic reactions to medications
• Problems breathing
• Bleeding, blood clots, infection

Risks rotator cuff surgery are:

• Failure of surgery to relieve symptoms
• Injury to a tendon, blood vessel or nerve

Before the Procedure

Tell your health care provider what medicines you are taking. This includes medicines, supplements, or herbs you bought without a prescription.

During the 2 weeks before your surgery:

• You may be asked to stop taking medicines that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), and other medicines.
• Ask your provider which medicines you should still take on the day of your surgery.
• If you have diabetes, heart disease, or other medical conditions, your surgeon will ask you to see your doctor who treats you for these conditions.
• Tell your provider if you have been drinking a lot of alcohol, more than 1 or 2 drinks a day.
• If you smoke, try to stop. Ask your provider for help. Smoking can slow wound and bone healing.
• Tell your surgeon about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery.

On the day of surgery:

• Follow instructions on when to stop eating and drinking.
• Take the medicines your surgeon told you to take with a small sip of water.
• Follow instructions on when to arrive at the hospital. Be sure to arrive on time.

After the Procedure

Follow any discharge and self-care instructions you are given.

You will be wearing a sling when you leave the hospital. Some patients also wear a shoulder immobilizer. This keeps your shoulder from moving. How long you wear the sling or immobilizer will depend on the type of surgery you had.

Recovery can take 4 to 6 months, depending on the size of the tear and other factors. You may have to wear a sling for 4 to 6 weeks after surgery. Pain is usually managed with medicines.

Physical therapy can help you regain the motion and strength of your shoulder. The length of therapy will depend on the repair that was done. Follow instructions for any shoulder exercises you are told to do.

Outlook (Prognosis)

Surgery to repair a torn rotator cuff is usually successful in relieving pain in the shoulder. The procedure may not always return strength to the shoulder. Rotator cuff repair can require a long recovery period, especially if the tear was large.

When you can return to work or play sports depends on the surgery that was done. Expect several months to resume your regular activities.

Some rotator cuff tears may not fully heal. Stiffness, weakness, and chronic pain may still be present.

These poorer results are more likely when the following are present:

• The rotator cuff was already torn or weak before the injury.
• Larger tears.
• After-surgery exercise and instructions are not followed.
• Older patients (over age 65).
• Smoking.

References

DeBerardino TM, Scordino L. Shoulder arthroscopy. In: Miller MD, Thompson SR, eds. DeLee and Drez's Orthopaedic Sports Medicine: Principles and Practice. 4th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 45.

Miller RH III, Asar FM, Throckmorton TW. Shoulder and elbow injuries. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics. Philadelphia, PA: Elsevier Mosby; 2013:chap 46.

Sperling JW. Open rotator cuff replair. In: Cole BJ, Sekiya JK. Surgical Techniques of the Shoulder, Elbow, and Knee in Sports Medicine. 2nd ed. Philadelphia, PA: 2013:chap 24.