WHAT IS THE ROTATOR CUFF ?

The rotator cuff is a series of four muscle-tendons that control motion of the shoulder joint. Tendons are like ropes which attach muscles to bones. Rotator cuff problems are common because of the anatomy of the shoulder. The rotator cuff tendon most commonly injured, the supraspinatus, lies between the humeral head (the ball at the top of the arm bone) and the acromion, (the bone that you can easily feel when you touch the top of the shoulder). Certain motions, especially overhead activities, can pinch or compress the rotator cuff between the humeral head and the acromion, sometimes referred to as "Impingement Syndrome".

HOW IS THE ROTATOR CUFF TORN ?

Rotator cuff injuries can occur in several ways. A traumatic injury can occur from falling onto an outstretched hand, elbow or shoulder. A more gradual, degenerative or chronic process can also occur, resulting in gradual loss of motion, function and increasing pain. In some cases, there may be a pre-existing problem that can be made worse by an accident or fall. A bone spur underneath the acromion may also contribute to rotator cuff pathology.

WHAT ARE THE COMMON SYMPTOMS ?

The most common symptoms that patients note with rotator cuff problems are pain in the shoulder area that does not usually radiate below the elbow. Patients may also note pain that frequently worsens at night due to inflammation or swelling of the rotator cuff. Patients with severe disruption of the rotator cuff are unable to lift their arm above shoulder level (i.e., to comb one’s hair or reach behind one’s back). Less severe damage to the tendons will simply produce pain with overhead activities.

WHAT IS SPECIAL ABOUT OUR APPROACH AND TECHNIQUES ?

Our goal is always to reconstruct a repairable rotator cuff. We prefer to complete the procedure arthroscopically. This technique leaves a much smaller scar, thus reducing postoperative pain, avoids incision of an uninjured, healthy deltoid muscle, improves speed and comfort of rehabilitation and decreases the chance of infection.

HOW IS THE ROTATOR CUFF REPAIRED ?

A diagnostic arthroscopy is performed initially to assess the condition of the glenohumeral (ball & socket) joint (underneath the rotator cuff) and the extent of damage. The arthroscope is then placed in the subacromial space (on top of the rotator cuff) to first perform a bursectomy (removal of inflammatory tissue) and subacromial decompression (smoothing the acromial spur).

The rotator cuff tear is then assessed arthroscopically and a determination is made based on tear size, shape, scarring and tissue quality, whether an arthroscopic versus mini-open or open repair will be performed. A variety of different instruments, implants, sutures and techniques are employed to complete the repair.

WHAT KIND OF FUNCTION CAN I EXPECT FROM A ROTATOR CUFF REPAIR ?

The goal of rotator cuff repair is to restore strength, function and provide pain relief. The final result depends on many factors, including: the severity of the initial tendon injury (size of tear), the quality of the tissue, strength of the repair and finally, the motion and strength that is ultimately able to be achieved by the patient in rehabilitation.

These injuries vary in size from ½ inch (small tear) to three or four inches (massive tear). The outcome of surgery is related to the severity of the problem, the size of the tear and the condition of the muscles and tendons of the rotator cuff and the shoulder.

If the quality of the tendon tissue is poor, or the tear is very large, a partial repair or debridement is completed. In these cases of massive tears, full function and strength may not be able to be restored, but often pain relief can be achieved.

WHAT IS SPECIAL ABOUT OUR APPROACH AND TECHNIQUES ?

To re-emphasize, our goal is always to reconstruct a repairable rotator cuff. We prefer to complete the procedure arthroscopically. This technique leaves a much smaller scar, thus reducing postoperative pain, avoids incision of an uninjured, healthy deltoid muscle, improves speed and comfort of rehabilitation and decreases the chance of infection.

DO I NEED TO HAVE ANY TESTS PRIOR TO SURGERY ?

Depending on your overall medical condition, you may need specific tests and/or a medical evaluation by your primary care physician. Within two weeks of your surgery, you may need several medical tests. These are done on an outpatient basis. Some people require blood tests and urinalysis. A chest X-Ray and an EKG are required if you are over 50. In select cases, a MRI (magnetic resonance image) is useful to assess the soft tissue structures around the shoulder and may help in predicting the severity of injury and in preoperative planning.

You should STOP taking any medication 2 weeks prior to surgery that may cause excessive bleeding. These include: Aspirin, NSAIDs (Non-steroidals) like Ibuprofen, Naprosyn, and Daypro. Tylenol is okay to continue.

WHAT TYPE OF ANESTHESIA IS USED ?

A regional block to make the shoulder numb may often be combined with general anesthesia for most rotator cuff repairs. Prior to surgery you will meet a member of the Anesthesia Department who will explain your anesthesia alternatives and address questions that you may have concerning anesthesia. On the morning of surgery, a member of the Anesthesia Department will again review your anesthesia options with you.

WHAT HAPPENS THE DAY OF SURGERY ?

You will arrive at the hospital approximately one hour before your scheduled surgery. The surgery will take approximately two to three hours and you will be in the recovery room for one hour so that your recovery from the anesthesia can be monitored. You will then go home.

NOTE: YOU MAY NOT EAT OR DRINK ANYTHING BEGINNING AT MIDNIGHT THE NIGHT PRIOR TO THE SURGERY.
If you must take medicines daily you should do so with just a sip of water. This should be cleared by the operating surgeon or by the anesthesiologist prior to the day of surgery.

WHAT HAPPENS AFTER SURGERY ?

Following surgery, you will have a bandage over your incision and your arm will be placed in a sling so that the repaired tendons can heal (this takes 6 weeks). Ice and a prescription for medications will be provided for your comfort. You should keep a pillow under your elbow on the operated side while lying in bed. Also keep a pad in your armpit to avoid skin maceration from sweating. In addition, you will be provided with dressings to change over your shoulder wound after 2 days.

HOW DO I CARE FOR MY SHOULDER ?

Two days after you go home, the bandage may be removed. You will see an incision covered with suture. Remove the surgical dressing and replace it with the 4x4s and tegaderm dressings that were provided to you on discharge. You will then be able to shower. Remove the sling and keep your arm at your side while showering. To give your wound time to heal, please DO NOT SOAK or SUBMERGE your operated shoulder under water, i.e., in a tub or whirlpool.

After your surgery call the office to make a follow-up appointment for approximately seven to ten days following your surgery. At that time, the stitches will be removed and you will again be instructed in what activities you may do.

WHAT CAN I DO AFTER SURGERY ?

You will need to wear the sling for 6 weeks so that the tissues can heal. During this time, you are permitted to use your elbow, wrist and hand below shoulder level, i.e. to feed yourself, write or type on the computer. You MUST do the gentle PASSIVE ONLY range of motion exercises 5X a day, while lying flat, as instructed by your physician. It is suggested that you avoid driving during the time you wear the sling, for safety reasons and to prevent injury to the operated area.

Many people can return to a desk job within seven (7) days following surgery. Returning to a job that is more strenuous will require more time. You are not permitted to lift anything greater than one or two pounds for the first six weeks and NOTHING OVERHEAD.

WHEN CAN I EXPECT TO RETURN TO MY PREVIOUS LEVEL OF ACTIVITY?

For the first 6 weeks, you will be doing passive stretching motions with your shoulder. At six weeks following surgery, you will be permitted to begin more vigorous strengthening exercises as the tendon heals. It can take six months to a year, to recover the full strength of your arm. The end result depends on the size of the tear, the conditions of the tendon and the muscles at the time of the surgery and how much time and effort you can devote to your rehabilitation.