Arthroscopic shoulder surgery for the treatment of rotator cuff tears: why, when and how it is done.

Edited By: Christopher J. Wahl, M.D., Suzanne L. Slaney, PA-C, ATC, MMS
Last updated Tuesday, May 16, 2006

Preparing for surgery

Preparation

Surgical rotator cuff repair is considered for healthy and motivated individuals in whom pain and weakness interfere with shoulder function and activity.

Successful surgery depends upon a partnership between the patient and the experienced shoulder surgeon. Patients should optimize their health to prepare for surgery.  Smoking should be stopped one month prior to surgery, and be avoided altogether for at least three months following surgery.  Any heart, lung, kidney, bladder, tooth, or gum problems should be managed before the shoulder surgery.  Any active infections will delay elective surgery to optimize the benefit and reduce the risk of shoulder joint infection.  The surgeon should be made aware of any health issues, including allergies and non-prescription and prescription medications being taken.  Some medications will need to be held or stopped prior to surgery.  For instance, aspirin and anti-inflammatory medications (Advil®, Motrin®, Alleve®, and other NSAIDs) should be discontinued as they will affect intra-operative and postoperative bleeding. 

Before surgery, patients should consider the limitations, alternatives and risks to surgery.  Patients must recognize that the procedure is a process and not an event:  the benefits of the surgery depend a large part on the patient’s willingness to apply effort to rehabilitation after surgery.

Patients must plan on being less active and functional for 12 to 16 weeks after the surgery.  Driving, shopping and performing overhead chores, lifting, and repetitive arm activities may be difficult or impossible during this time.  Plans for the necessary assistance need to be made before surgery.  For individuals who live alone or those without readily-available help, arrangements for home help should be made well in advance.  Usually, the complete rehabilitation and restoration to normal function can take as long as 6 months.

Timing

Rotator cuff surgery can be delayed until the time that suits the patient best. In persons who have longstanding symptoms it is probably prudent to consider surgery before secondary atrophy and arthritic changes can develop.

Costs

The surgeon’s office should provide a reasonable estimate of:

• the surgeon’s fee
• the hospital fee, and
• the degree to which these should be covered by the patient’s insurance

Surgical team

Rotator cuff repair, particularly when done through the arthroscope is a technically demanding procedure that must be performed by an experienced, specially trained shoulder surgeon in a medical center accustomed to performing complex arthroscopic shoulder procedures on a weekly basis. Patients should inquire as to the specific training the surgeon has undergone to perform such procedures (i.e. a fellowship-trained, sports medicine/shoulder specialist familiar with arthroscopic techniques and equipment) and also as to how many of these procedures the surgeon and the medical center perform on a yearly basis.

Finding an experienced surgeon

While surgeons who are capable of performing simple arthroscopic procedures are relatively easy to find, complex reconstructive surgeries in the shoulder (like arthroscopic stabilization procedures and arthroscopic rotator cuff repairs) demand a degree of highly-specialized training. Many capable surgeons will have completed a fellowship (additional year or two of training) specifically in arthroscopic techniques, shoulder surgery and sports medicine.  A qualified sports medicine surgeon should be comfortable with both open (traditional) and arthroscopic techniques, and tailor the appropriate treatment to the problem to be addressed.  Fellowship-trained surgeons may be located through university schools of medicine, county medical societies, or state orthopaedic societies.  Other resources include professional societies such as the American Orthopaedic Society for Sports Medicine (AOSSM) or the American Academy of Orthopaedic Surgeons (AAOS), or the American Shoulder and Elbow Surgeon’s Society (ASES) 

Facilities

Arthroscopic rotator cuff repair is usually performed in a qualified ambulatory surgical center or major medical center that performs such procedures on a regular basis. These centers have surgical teams, facilities, and equipment specially designed for this type of surgery.  For those patients who require an overnight stay, the centers have nurses and therapists who are accustomed to assisting patients in their recovery from shoulder stabilization.

Surgery for Rotator cuff tears, arthroscopic, minimally-invasive and open management at the University of Washington

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