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Get The Facts:
Rotator Cuff Surgery
It is important to have some basic understanding of rotator surgery whether you are just exploring options or have already decided to undergo shoulder surgery. This question/answer format is a brief overview to better prepare you for rotator cuff surgery.
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What is the rotator cuff and how does it function?
What are the factors in deciding to have rotator cuff surgery?
How is the rotator cuff repaired?
What are the complications or potential risks of rotator cuff surgery?
If I elect for surgery what is my responsibility prior to surgery?
How long does the surgery take, and what are my expectations immediately after surgery?
What is the rotator cuff and how does it function?
The rotator cuff is a large tendon structure that elevates and rotates the arm against the shoulder. Four large muscles form this broad based tendon which then connects to the long bone of your arm or humerus. The top of the rotator cuff is protected by a large process which is an extension of the shoulder blade called the acromion. This acts as a roof or protector of the rotator cuff. The rotator cuff tendon is the widest tendon of the body and is very important for lifting activities above shoulder level or any throwing activities.
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What are the factors in deciding to have rotator cuff surgery?
- Type of rotator cuff tear: If the rotator cuff is simply strained or has a partial tear, conservative management is warranted. If there is a full thickness tear but it is very small arthroscopy may be the best alternative and an open rotator cuff surgery is not required.
- Age: We know that as many patients reach the sixth and seventh decade of life small or medium size rotator cuff tears are well tolerated and asymptomatic. Patients younger than 60 generally do not tolerate a full thickness torn rotator cuff and surgery is recommended universally.
- Failure of conservative treatment and injections: Most patients should have a trial of rotator cuff exercises and an injection prior to proceeding to open rotator cuff surgery. Complete resolution of symptoms have occurred with conservative treatment in some small rotator cuff tears.
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How is the rotator cuff repaired?
In 90% of tears the edge of the rotator cuff tendon pulls away from bone. This requires the use of suture to be placed a the edge of the tendon and then brought out through drill holes in the bone and tied outside. A new device allows the suture to be placed directly into the bone with the use of a suture anchor. This is a small metallic device similar to a expandable wall mount that allows us to place suture anywhere within the bone and avoid the need for drilling holes. In both cases the edge of the torn rotator cuff is brought back to an area of bleeding bone and secured with sutures.
During surgery bone spurs and excessive bone causing impingement are also removed.
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What are the complications or potential risks of rotator cuff surgery?
The two most common complications following rotator cuff surgery are:
- Permanent loss of range of motion of the shoulder.
- Failure of the repair with further tearing of the tendon, or suture failure.
By far the greatest complication is loss of range of motion in the shoulder. This is why passive range of motion with physical therapy is so critical during the first 6 weeks post operatively. If the therapist is allowed to move your shoulder you will avoid the complications of permanent loss of motion.
It is unknown why 15% of rotator cuff repairs fail, but this is due to the poor blood supply of the remaining rotator cuff tendon that eventually reruptures. Patients that do not follow instructions and actively lift with their shoulder during their first 6 weeks are responsible for many of the failures.
The other complications are standard for any open surgical procedures of the shoulder including; infection, excessive bleeding in the shoulder, nerve damage, blood clots to the upper extremity, in addition to anesthetic complications such as pneumonia, heart attack or stroke. Fortunately this second set of complications represents less than 3% of all open shoulder procedures.
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If I elect for surgery what is my responsibility prior to surgery?
We recommend that you do not eat or drink after midnight the night before surgery. In addition 3-5 days prior to surgery we ask that you discontinue all blood thinners, anti inflammatory medications or aspirin products. In this way you can hopefully avoid additional bleeding at the shoulder following surgery. You should shower the night before surgery and we prefer you to empty your bladder one hour prior to the operation.
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How long does the surgery take, and what are my expectations immediately after surgery?
In general open rotator cuff Repair will last between 1-2 hours. The average time is 1 hour and 15 minutes. However if you have a large tear requiring mobilization of the rotator cuff the procedure will last longer. Following the procedure you will be in the recovery room approximately 1 additional hour until your are fully alert and awake and your blood pressure is stable.
70% of my patients stay 1 night in the hospital and are released the morning following. 30% are able to return home the same day and the operation is considered an outpatient procedure. We will discuss which option is best for you. If you desire to go home a special nerve block at the base of your neck will be required in order to provide anesthesia and pain relief immediately following surgery so you may be released home. If I suspect a large rotator cuff tear I would prefer you stay overnight because of the need for antibiotics and also to monitor extra bleeding.
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