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 1 - Rotator cuff, viewed from above
Rotator cuff – normal rotator cuff attachment around the humeral head
Rotator cuff – small rotator cuff tear
Rotator cuff – large rotator cuff tear
Rotator cuff – large rotator cuff tear with poor quality tissue
Rotator cuff – large rotator cuff tear with early cuff tear arthropathy
Rotator cuff – irreparable rotator cuff tear
Rotator cuff – massive rotator cuff tear with rotator cuff tear arthropathy
Rotator cuff – rotator cuff tear arthropathy
Rotator cuff – rotator cuff tear arthropathy with collapse of the humeral head
Figure 2 - Supraspinatus tear of the rotator cuff
Figure 3 - Exercises for rotator cuff tears
Figure 4 - Location of incision
Figure 6 - Continuous passive motion machine
Figure 8 - Shoulder exercises
Summary
Overview
The rotator cuff is a group of four tendons that blend together to
help stabilize and move the shoulder. Each of the four tendons connects a muscle
originating on the shoulder blade (scapula) to part of the upper part of the
arm bone (humerus). The names of these muscle-tendon components of the rotator
cuff are:
- the supraspinatus,
which runs over the top of the ball of the shoulder joint (humeral head);
- the subscapularis,
which runs across the front of the humeral head; and
- the infraspinatus
and the teres minor, which run across the back of the humeral head.
Tears in the rotator cuff result from a combination of injury and
weakening of the tendon from wear and tear, disuse, repeated use of steroid (cortisone)
injection, and smoking. The extent of injury necessary to tear the cuff depends
on the quality of the tendon. Young, healthy rotator cuff tendon is almost
impossible to tear. However, older, multiply injured, multiply injected tendons
or tendons in a smoker may tear with no injury at all. Tears in younger
individuals are more likely to extend only part way through the tendon (partial
thickness tears). Tears in older individuals are more likely to tear completely
through the tendon (full thickness tears) and to involve multiple tendons.
Rotator cuff tears range from small to massive. Here is a gallery of
rotator cuff pathology:
- Small tear
involving the supraspinatus tendon only
- Large tear involving the supraspinatus and
infraspinatus
- Large rotator cuff tear with poor quality tissue
- Large rotator cuff tear with early loss of the
cartilage of the humeral head (rotator cuff tear arthropathy)
- Large rotator cuff tear that is not reparable
- Massive rotator cuff tear with rotator cuff tear
arthropathy
- Complete failure of rotator cuff with rotator
cuff tear arthropathy
- Rotator cuff tear arthropathy with collapse of
the humeral head
The types of injuries most likely to cause cuff tears are those in
which the elevated arm is forced downward (an eccentric force) or when the
shoulder attempts a sudden, jerky lift (a concentric force).
Full thickness tears do not heal by themselves because the muscles
pull the edges of the tear apart. However, it is possible for full or partial
thickness tears to stabilize, leaving the shoulder with reasonable comfort and
function.
The more force necessary to produce a tear, the more likely it is that
the tear will be surgically repairable. Healthy tendon requires a major force
to tear it. Tears resulting from major injury can usually be repaired
successfully if surgery is not delayed more than several weeks.
Weakened,
degenerative cuff tissue is more easily torn, even by normal activities.
Durable repair of these tears may not be possible because of the lack of
sufficient quantity and quality of tendon tissue. For these reasons, patients
should seek prompt evaluation of shoulder weakness by an experienced shoulder
surgeon, especially if the weakness comes on suddenly, or after an injury.
A surgeon experienced
in shoulder surgery can repair a rotator cuff tear if there is enough good
quality tendon tissue.
Characteristics of rotator cuff tears
Individuals with rotator cuff tears usually notice weakness, pain, and
loss of the ability to use the shoulder for their usual activities.
Commonly, they have difficulty sleeping on the affected shoulder and
have a limited range of active motion. Some people with rotator cuff
tears notice a catching or grinding feeling when the shoulder is moved.
Rotator cuff tears usually get worse over time, but the rate of this
progression varies widely.Types
Rotator cuff tears may involve the entire thickness of the tendon
(full thickness rotator cuff tears) or they may be incomplete (partial
thickness).
Full thickness tears may involve only part of one tendon (usually
the supraspinatus). They may extend to become massive, involving
multiple tendons, as shown in the figure.
Rotator cuff tears may be degenerative (the defect arose in tendon
of poor quality) or they may be traumatic (the tear arose from a major
injury to otherwise healthy tissue). Cuff tear arthropathy refers to
the combination of a massive cuff tear and arthritis of the shoulder
joint.
Similar conditions
Rotator cuff disease must be distinguished from shoulder arthritis,
arthritis of the acromioclavicular joint, subacromial bursitis, frozen
shoulder, and neck arthritis, each of which may produce similar
symptoms.
Shoulder arthritis usually causes pain and limited shoulder motion.
X-rays confirm the presence of arthritis. Arthritis of the
acromioclavicular joint usually produces pain localized to the top
front of the shoulder that is made worse by using the arm in front of
the body. Shoulder strength is usually normal. Subacromial bursitis may
cause catching and pain in the shoulder, but shoulder strength is
maintained. Frozen shoulder is characterized by shoulder stiffness, but
the shoulder is usually strong. Neck arthritis with nerve impingement
may cause shoulder pain and weakness that is worse when the head is
held in certain positions. In this case, electromyography may identify
the presence of nerve involvement in the neck. Some have used the term
"impingement syndrome" to refer to various types of cuff disease.
However, modern diagnostic approaches usually permit a more specific
diagnosis.
Incidence and risk factors
Conditions of the rotator cuff are the most common cause of problems
of the shoulder. They are more likely to be found in people over the
age of 40, smokers, and individuals who have had multiple steroid
(cortisone) injections. People over the age of 40 who dislocate their
shoulders are likely to have cuff tears. Those who have a cuff tear in
one shoulder are likely to have similar problems in the opposite
shoulder.
Diagnosis
A physician diagnoses rotator cuff disease by reviewing the
patient's history, performing a thorough physical examination of the
joint, taking the proper X-rays, and obtaining confirming imaging
studies (such as a shoulder ultrasound or MRI). The examination of a
shoulder with cuff disease reveals weakness or pain on exertion of the
shoulder against isometric resistance. Sometimes the shoulder is stiff
or noisy on movement.
X-rays of the shoulder are usually normal in the presence of cuff
disease--they are taken to exclude other problems. Rotator cuff tendons
do not show on ordinary X-ray examinations of the shoulder.
One method for diagnosis is ultrasound. In the hands of an
experienced sonographer, dynamic shoulder ultrasound is a quick, safe,
and reliable method for documenting the status of the rotator cuff
tendons. By reflecting sound waves off the tendons, sonographic images
are created as the tendons move. Defects in the tendons may be revealed
on these images. Magnetic resonance imaging (MRI) is another method for
imaging the rotator cuff tendons. One risk is that some patients become
claustrophobic during MRI examinations. A third method that has been
used to evaluate the integrity of cuff tendons is shoulder
arthrography. In this technique, dye is injected into the joint so that
leaks through the cuff can be seen on X-rays.
It is essential that the shoulder surgeon establish the diagnosis of rotator cuff before surgical treatment is considered.
Medications
Medications
cannot help a torn tendon heal. However, mild pain-relieving
medications may make shoulders with rotator cuff tears more
comfortable. Cortisone (steroid) injections in the area of the cuff
tendons may lessen the discomfort from the cuff problem, but may also
weaken the tendon tissue. Multiple injections of steroids are
discouraged for this reason.Exercises
While prompt surgery is usually recommended for acute cuff tears in generally healthy shoulders, exercises
may be helpful in maintaining the flexibility and strength of joints
with long-standing cuff tears. In most cases, these exercises can be
done in the patient's home with little equipment. Shoulder exercises
are best performed gently several times a day on an ongoing basis. The
exercises are not dangerous if they are performed gently so that they
do not risk enlarging the cuff tear.
The figures show two examples of these exercises. The illustration
on the left shows the patient using the left arm to help lift the stiff
right shoulder in a forward direction. The illustration on the right
shows the patient using the left arm to gently stretch the stiff right
arm in external rotation using a yardstick.
Sometimes physical therapists suggest other types of therapy.
Patients should learn the possible risks of these approaches as well as
their costs and anticipated effectiveness.
Possible benefits of rotator cuff surgery
When combined with a good rehabilitation effort, rotator cuff
surgery allows people to regain much of the lost comfort and function
in shoulders with cuff disease. In experienced hands, this procedure
can address the restricting scar tissue and roughness that frequently
accompany cuff disease. If the quantity and quality of the tissue is
good, surgery can help repair the tendon back to the bone from which it
has been torn. This is most likely to succeed soon after a cuff tear in
otherwise healthy shoulders of non-smokers who have not had multiple
cortisone injections.
Rotator cuff surgery can improve the mechanics of the shoulder, but
cannot make the joint as good as it was before the cuff tear. In many
cases, the tendons and muscles around the shoulder have been weakened
from prolonged disuse before the surgery. The tissue may be
insufficient for a strong repair. In such cases the mechanics of the
shoulder may be improved by carefully smoothing out the cuff area and
moving the shoulder immediately after surgery so that new scars are not
formed.
If the cuff is repaired, it takes months before the tendon is
strongly healed to the bone. During this time, strengthening exercises
must be avoided so that healing is not impaired. After the healing, it
may take months of gentle exercises before the shoulder achieves
maximal improvement.
The effectiveness of the procedure depends on the health and
motivation of the patient, the condition of the shoulder, and the
expertise of the surgeon. When performed by an experienced surgeon,
rotator cuff surgery usually leads to improved shoulder comfort and
function. The greatest improvements are in the ability of the patient
to sleep, perform activities of daily living, and engage in non-contact
recreational activities.
Repair of Rotator Cuff Tears
Rotator cuff tears are common causes of shoulder weakness and pain that can often be improved by expert shoulder surgery.Types of surgery recommended
When healthy tendons of the rotator cuff have been recently torn, it
is often possible to perform a rotator cuff repair. When a repair
cannot be accomplished because of insufficient tendon quantity and
quality, the comfort and function of the shoulder are often improved by
a "smooth and move" procedure in which the upper surface of the rotator
cuff and the arm bone (humerus) are smoothed and immediate
post-operative motion is used to prevent the reformation of scar
tissue. Partial thickness cuff tears may be treated by detaching loose
tendon fibers along with the "smooth and move" procedure.
A procedure known as acromioplasty has been advocated for the
treatment of cuff disease. Recently, however, the routine use of this
procedure has been questioned.
Who should consider rotator cuff surgery?
Rotator cuff surgery is considered for patients with either:
- acute tears of otherwise healthy tendons, or
- chronic tears that remain weak or painful after a gentle exercise program.
What happens without surgery?
Before cuff surgery is undertaken, the patient needs to:
- be in optimal health,
- understand and accept the risks and alternatives of surgery, and
- understand the post-operative rehabilitation program.
In cases of chronic cuff tears, rotator cuff surgery can be
performed whenever conditions are optimal. Sometimes the pain and
stiffness from rotator cuff disease will stabilize at a level that is
acceptable to the patient. In such cases the patient can delay surgery
without compromising the potential for future surgery, as long as the
surgeon monitors the cuff tear to make sure it is not enlarging.
Sequential shoulder sonography is particularly useful in sequentially
following the integrity of the cuff.
In the case of an acute rotator cuff tear in otherwise healthy
tissue, the best chance of achieving an excellent result is surgical
repair within the first month after the tear.
Rotator cuff surgery is not an emergency. If possible, acute rotator
cuff tears should be considered for repair within the first month after
the injury. Rotator cuff surgery in chronic cuff tears is an elective
procedure that can be scheduled when circumstances are optimal. In both
instances the patient has time to become informed and to select an
experienced surgeon.
Surgical options
Several variations of cuff surgery are used to manage cuff tendon
problems. One important goal of this surgery is to allow the smooth
passage of the upper arm bone (humerus) beneath what is known as the
coracoacromial arch. This is usually accomplished by removing scar
tissue, chronic bursitis, bony prominences, and irregular tendon edges.
The combination of this smoothing with immediate post operative motion
is known as the "smooth and move" procedure. When there is sufficient
quantity and quality of tendon tissue, the torn edge of the cuff tendon
is anchored to the humerus from which it was torn, so that healing back
to the bone can take place.
Some have advocated the repair of rotator cuff tears using shoulder
arthroscopy. However, it is not clear that this more complicated
approach has advantages over an expertly done direct open repair.
Others have suggested the use of various biological or artificial
grafts or tendon transfers to bridge otherwise irreparable rotator cuff
defects. The superiority of these complex procedures to the "smooth and
move" procedure has yet to be demonstrated.
Effectiveness
In the hands of an experienced surgeon, rotator cuff surgery can
effectively restore comfort and function to the shoulder of a
well-motivated patient. Often, the greatest benefits are an improved
ability to sleep on the affected shoulder and to perform usual
activities of daily living. As long as the shoulder is cared for
properly and subsequent injuries are avoided, the benefit can last for
decades. However, it is important to recognize that surgery cannot
improve the basic quality of the tendon tissue. Thus, repair of
poor-quality tissue is often followed by recurrent tears.
Risks
The risks of rotator cuff surgery include, but are not limited to, the following:
- infection
- injury to nerves and blood vessels
- irreparability of the rotator cuff tendon
- stiffness of the joint
- re-tear of the repaired rotator cuff
- pain
- the need for additional surgeries
There are also risks associated with anesthesia. An experienced
shoulder surgery team will use special techniques to minimize these
risks, but cannot eliminate them completely.
Managing risk
Many of the risks of rotator cuff surgery can be managed effectively if they are promptly identified and treated.
Infections may require a "wash out" in the operating room and
subsequent antibiotic treatment. Blood vessel or nerve injury may
require repair. Stiffness may require exercises or additional surgery.
Retear of the repaired rotator cuff may require consideration of
additional surgery.
If the patient has questions or concerns about the course after surgery, the surgeon should be informed as soon as possible.
Repair of Rotator Cuff Tears
Rotator cuff surgery can optimize the comfort and function of shoulders with cuff tears.Preparation
Rotator cuff surgery is considered for healthy and motivated
individuals in whom rotator cuff tears interferes with shoulder
function.
Successful rotator cuff surgery depends on a partnership between the
patient and the experienced shoulder surgeon. The patient's motivation
and dedication are important elements of the partnership.
Patients should optimize their health so that they will be in the
best possible condition for this procedure. Smoking should be stopped a
month before surgery and not resumed for at least three months
afterwards--ideally, never. This is because smoking interferes with the
healing of the rotator cuff repair and the strength of the cuff tendon.
Any heart, lung, kidney, bladder, tooth, or gum problems should be
managed before surgery. Any infection may be a reason to delay the
operation.
The patient's shoulder surgeon needs to be aware of all health
issues, including allergies and non-prescription and prescription
medications being taken. Some of these may need to be modified or
stopped. For instance, aspirin and anti-inflammatory medication may
affect the way the blood clots.
Costs
The surgeon's office should be able to provide a reasonable estimate of:
- the surgeon's fee, and
- the hospital fee.
Surgical team
Rotator cuff surgery is a technically demanding procedure that is
ideally performed by an experienced shoulder surgeon in a medical
center accustomed to performing these procedures at least several times
a month. Patients should inquire as to the number of rotator cuff
repairs that the surgeon performs each year and the number of these
procedures performed in the medical center each year.
Surgeons specializing in rotator cuff surgery may be found through
university schools of medicine, county medical societies, state
orthopedic societies, or professional groups such as the American Shoulder and Elbow Surgeons.
Rotator cuff surgery is often performed in a major medical center
that performs these procedures on a regular basis. These centers have
surgical teams and facilities specially designed for this type of
surgery. They also have nurses and therapists who are accustomed to
assisting patients in their recovery from rotator cuff surgery.
Repair of Rotator Cuff Tears
Timing of the surgery and recovery period
Surgery for chronic cuff tears can be delayed until the time that is
best for the patient's overall well-being. Acute rotator cuff tears
(those that occur suddenly) have the best chance of being strongly
repaired if the surgery is carried out within a month of the tear.
After rotator cuff repair, the patient needs to plan on being less
functional than usual for twelve or more weeks after the procedure. The
shoulder should not be used with the elbow away from the side for 3
months after a rotator cuff repair. Lifting, pushing, pulling, and many
activities of daily living place stresses on the rotator cuff and can
place excessive tension on the cuff repair, risking failure of the
repair. Driving, shopping, and performing usual work or chores may be
difficult during this time. Plans for necessary assistance need to be
made before surgery. For people who live alone or those without readily
available help, arrangements for home help should be made well in
advance.
The shoulder surgeon should answer any questions about the surgery or the recovery period.
Technical details
Rotator cuff surgery is a highly technical procedure; each step plays a critical role in the outcome.
After the anesthetic has been administered and the shoulder has been
prepared, a cosmetic incision is made over the top front corner of the
shoulder, as shown in figure 1.
This incision allows access to the seam between the front and middle
parts of the deltoid muscle. Splitting this seam allows access to the
rotator cuff without detaching or damaging the important deltoid
muscle, which is responsible for a significant portion of the
shoulder's power. All scar tissue is removed from the space beneath the
deltoid and the acromion (part of the shoulder blade to which the
deltoid attaches). Thickened bursa and the rough edges of the rotator
cuff and humerus (upper arm bone) are also smoothed to make sure that
they pass smoothly beneath the acromion and deltoid.
The edges of the cuff tendons are identified and the quality and quantity of the cuff tissue is determined.
The goal of the repair is to reattach good quality tendon to the
location on the arm bone from which it was torn. If the tendon cannot
reach this spot with the arm at the side of the body, the shoulder
surgeon releases the tendon from the surrounding tissues. If good
quality tendon will not reach its attachment site after these releases,
the cuff tear is deemed to be irreparable. In this situation the
useless tendon is cut out and the shoulder is again examined to assure
smooth and full motion. Again, achieving this smooth movement may
require trimming of the tendon edges or the bone of the upper humerus.
Occasionally, it may be necessary to perform an acromioplasty, a
procedure in which part of the bone overlying the rotator cuff is
removed. Acromioplasty is avoided unless it is necessary because it
increases the risk of weakening the deltoid and causing scar tissue.
If the rotator cuff is repairable, a groove or trough is fashioned
in the normal attachment site for the cuff, as shown in figure 2.
Sutures (lengths of surgical thread) draw the edge of the tendon
securely into the groove to which it is to heal. This method of
attachment leaves a smooth upper edge of the cuff repair to glide
beneath the acromion and deltoid and avoids possible problems with
suture anchors. After the cuff is repaired, the deltoid muscle and skin
are closed.
Because the deltoid is not detached from the acromion in this surgical approach, it is called the "deltoid on" approach.
Anesthetic
Rotator cuff surgery may be performed under a general anesthetic or a
brachial plexus nerve block. A brachial plexus block can provide
anesthesia for several hours after the surgery. The patient may wish to
discuss their preferences with the anesthesiologist before surgery.Length of rotator cuff surgery
Rotator cuff surgery usually takes approximately one hour. However, the
preoperative preparation and the postoperative recovery may add several
hours to this time. Patients often spend two hours in the recovery room
and about two days in the hospital 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.
Recovery of comfort and function after cuff surgery continues for 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.
Physical therapy
Shoulders with rotator cuff disease may be stiff. One of the major
goals of rotator cuff surgery is to relieve much of this 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 tissue so that
after surgery the patient needs only to maintain the range of motion
achieved at the operation. Later on, once the shoulder is comfortable
and flexible, and after the cuff repair has healed (usually three
months after surgery), strengthening exercises and additional
activities are started.Rehabilitation options
It is often most effective for the patient to carry out their own
exercises so that they are done frequently, effectively and
comfortably. Usually, a physical therapist or the surgeon instructs the
patient in the exercise program and advances it at a rate that is
comfortable for the patient.
Can rehabilitation be done at home?
In general the exercises are best performed by the patient at home.
Occasional visits to the surgeon or therapist may be useful to check
the progress and to review the program.Usual response
Patients are almost always satisfied with the increases in range of
motion, comfort, and function that they achieve with the exercise
program. If the exercises are uncomfortable, difficult, or painful, the
patient should contact the surgeon promptly.
Risks
This is a safe rehabilitation program with little riskDuration of rehabilitation
For the first twelve weeks after surgery, emphasis is placed on
optimizing the flexibility and range of motion of the shoulder through
gentle stretching exercises. After three months, these stretching
exercises are continued and strengthening exercises are added (see
movies 2-5).
Once the range of motion and strength goals are achieved, the
exercise program can be cut back to a minimal level. However, gentle
stretching is recommended on an ongoing basis.
QuickTime movies
Returning to ordinary daily activities
In general, patients are able to perform gentle activities of daily
living with the operated arm at the side starting two to six weeks
after surgery. Walking with the arm protected is strongly encouraged.
Driving should wait until the patient can perform the necessary
functions comfortably and confidently. Recovery may take three months
if the surgery has been performed on the right shoulder, because of the
increased demands on the right shoulder for shifting gears.
With the consent of their surgeon, patients can often return to
activities such as swimming, golf and tennis at six months after their
surgery.
Long-term patient limitations
Patients should avoid activities that involve major impact (chopping
wood, contact sports, sports with major risk of falls) or heavy loads
(lifting of heavy weights, heavy resistance exercises). These
activities may increase the chance of repeat rotator cuff tear.
Costs
The surgeon and therapist should provide information on the usual cost
of the rehabilitation program. The program is quite cost-effective,
because it is based heavily on home exercises.
The rehabilitation after rotator cuff surgery is carried out largely by the patient.Summary of rotator cuff surgery for rotator cuff tears
In the hands of an experienced surgeon, rotator cuff surgery can be a
most effective method for restoring comfort and function to shoulders
with rotator cuff tears in a healthy and motivated patient.
Pre-planning and persistent rehabilitation efforts will help assure the
best possible result for the patient.
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Rotator cuff surgery can help restore comfort and function to shoulders with rotator cuff tears.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