Repair of Rotator Cuff Tears: Surgery for shoulders with torn rotator cuff tendons can lessen shoulder pain and improve function without acromioplasty.
Edited By: Frederick A. Matsen III, M.D., Winston J. Warme, MD
Last updated Wednesday, October 28, 2009
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Figure 6 - Continuous passive motion machine
Recovering from surgery
Recovery of comfort and function after cuff surgery continues for a year after surgery.Pain and pain management
Rotator cuff surgery is a major surgical procedure that involves
cutting of skin, release of scar tissue, and suturing of tendons and
bone. The pain from this surgery is managed by the anesthetic and by
pain medications. Immediately after surgery, strong medications (such
as morphine or Demerol) are often given by injection. Within a day or
so, oral pain medications (such as hydrocodone or Tylenol with codeine)
are usually sufficient.
Initially, pain medication is administered usually intravenously or
intramuscularly. Sometimes patient controlled analgesia (PCA) is used
to allow the patient to administer the medication as needed.
Hydrocodone or Tylenol with codeine are taken by mouth. Intravenous
pain medications are usually needed only for the first day or two after
the procedure. Oral pain medications are usually needed only for the
first two weeks after the procedure.
Pain medications can be very powerful and effective. Their proper
use lies in the balancing of their pain relieving effect and their
other, less desirable effects. Good pain control is an important part
of the postoperative management.
Pain medications can cause drowsiness, slowness of breathing,
difficulties in emptying the bladder and bowel, nausea, vomiting, and
allergic reactions. Patients who have taken substantial narcotic
medications in the recent past may find that usual doses of pain
medication are less effective. For some patients, balancing the benefit
and the side effects of pain medication is challenging. Patients should
notify their surgeon if they have had previous difficulties with pain
medication or pain control.
Hospital stay
After surgery the patient spends an hour or so in the recovery room.
A drainage tube is sometimes used to remove excess fluid from the
surgical area. The drain is usually removed on the second day after
surgery. Bandages cover the incision. They are usually changed the
second day after surgery.
Recovery and rehabilitation in the hospital
Shoulder motion soon after rotator cuff surgery helps achieve best
possible shoulder function. Shoulders with cuff disease may have
substantial scarring and may be stiff. One of the major goals of
rotator cuff surgery is to relieve any stiffness. However, after
surgery scar tissue will tend to recur and limit movement unless motion
is started immediately. This early motion is facilitated by the
complete surgical removal of the scar tissues so that after surgery the
patient needs only to maintain the range of motion achieved at the
operation.
A continuous passive motion (CPM) machine is often used to gently
move the shoulder in the recovery room immediately after surgery. The
CPM, shown in figure 6 and movie 1, is continued for the first few days
after surgery whenever the patient is in bed.
During the hospitalization, the patient learns a simple
rehabilitation program that will be used to maintain the range of
motion at home after discharge.
Figure 7 shows the exercises used to maintain elevation and rotation
of the arm. On the day of surgery or on the day after, the physical
therapist teaches the patient gentle range of motion exercises.
Usually, the patient is shown how to stretch the shoulder forward and
out to the side, preventing stiffness and adhesions.
QuickTime movie
Hospital discharge
Patients are discharged as soon as:
- the incision is dry,
- the shoulder is comfortable with oral pain medications,
- the patient feels comfortable with the plans for managing the shoulder,
- the patient can perform the range of motion exercises, and
- the home support systems for the patient are in place.
Discharge is usually on the second or third day after surgery.
Convalescent assistance
Walking and use of the arm (with the elbow at the side) for gentle activities are encouraged soon after surgery.
If a cuff repair has been performed, the arm must be used only with
the elbow at the side and only for very gentle activities so that the
repair is protected. These precautions remain in place for three months
until the initial healing of the cuff repair is complete.
The patient's specific limitations can be specified only by the
surgeon who performed the procedure. It is important that the repaired
tendons not be challenged until they have had a chance to heal. Usually
the patient is asked to lift nothing heavier than a cup of coffee (with
the elbow at the side) for the first three months after the surgery.
Management of these limitations requires advance planning to
accomplish the activities of daily living during the period of
recovery.
Patients usually require some assistance with self-care, activities
of daily living, shopping, and driving for approximately three months
after surgery. Patients usually go home after this surgery, especially
if there are people at home who can provide the necessary assistance,
or if such help can be arranged through an agency. In the absence of
home support, a convalescent facility may provide a safe environment
for recovery.
Recovery of comfort and function after rotator cuff surgery
continues for many months after the surgery. Improvement in some
activities may be evident as early as three months. With persistent
effort, patients make progress for as long as a year after surgery.
Effects of general health on healing
The healing after rotator cuff surgery can be compromised by
smoking, poor nutrition, and medications such as cortisone. Diabetes
can cause additional scar tissue. Heart and lung disease, as long as
they are well managed, do not seem to have an effect.
Surgery for rotator cuff tears at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington
If you are interested in making an appointment to discuss this procedure in Seattle, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-BONE (2663) to make an appointment. Our clinical center is located in Seattle Washington, USA
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