The rotator cuff consists of muscles and tendons that hold the shoulder in place. It is one of the most important parts of the shoulder. The rotator cuff allows a person to lift his and her arm and reach up. It stabilizes the ball-and-socket joint of the shoulder and allows for normal shoulder mechanics. An injury to the rotator cuff, such as a tear, may happen suddenly when falling on an outstretched hand or develop over time due to repetitive activities. Rotator cuff degeneration and tears may also be caused by aging.
If the rotator cuff is injured, it may need to be repaired surgically. This may include shaving off bone spurs that are pinching the shoulder, and repairing torn tendons or muscles in the shoulder. Surgical techniques that may be used to repair a tear of the rotator cuff include arthroscopy, open surgery, or a combination of both. The goal of rotator cuff repair surgery is to help restore the function and flexibility of the shoulder and to relieve the pain that cannot be controlled by other treatments.
Reasons for the procedure
Injuries to the shoulder are common. Athletes and construction workers often have rotator cuff injuries due to repetitive movement and overuse of the shoulder. The rotator cuff may be damaged from a fall or other injury to the shoulder. Damage may also occur slowly over time. In older patients, there may not be an injury or event to cause the tear. The damage may be due to:
- Strains or tears in the rotator cuff.
- Inflammation of the bursa (bursitis) in the shoulder.
- Inflammation of the tendons (tendinitis) in the shoulder.
Recurrent pain, limited ability to move the arm, and muscle weakness are the most common symptoms.
If medical treatments are not satisfactory, rotator cuff repair surgery may be an effective treatment. Medical treatments for rotator cuff injury may include, but are not limited to, the following:
- Nonsteroidal anti-inflammatory medications
- Strengthening and stretching exercises
- Steroid injections
Rotator cuff surgery may be performed using an arthroscope. An arthroscope is a small, tube-shaped instrument that is inserted into a joint. It consists of a system of lenses, a small video camera, and a light for viewing. The camera is connected to a monitoring system that allows the doctor to view a joint through a very small incision. The arthroscope is often used in conjunction with other tools that are inserted through another incision.
An open repair may be performed if the rotator cuff injury cannot be repaired using arthroscopy. In some cases, a tendon graft and joint replacement may be necessary.
There may be other reasons for your doctor to recommend rotator cuff repair.
Risks of the procedure
As with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to, the following:
- Re-rupturing of rotator cuff
- Damage to nerves and vessels
- Blood clots in the legs or lungs
The joint pain may not be relieved by the surgery. You may not recover full range of motion in the shoulder joint.
Nerves or blood vessels in the area of surgery may be injured, resulting in weakness or numbness.
There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.
During the procedure
Rotator cuff repair may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor’s practices.
Rotator cuff repair may be performed while you are asleep under general anesthesia, or while you are awake under local or regional anesthesia. If regional anesthesia is used, you will have no feeling from your shoulder down. The type of anesthesia will depend on the specific procedure being performed. Your doctor will discuss this with you in advance.
Generally, rotator cuff repair surgery follows this process:
- You will be asked to remove clothing and will be given a gown to wear.
- An intravenous (IV) line may be started in your arm or hand.
- You will be positioned on the operating table.
- The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
- The skin over the surgical site will be cleansed with an antiseptic solution.
- The doctor will make an incision in the shoulder area. The incision will vary depending on the type of surgery (open surgery, arthroscopy, or a combination of both) that may be performed.
- The arthroscope (if used) will be inserted through the incision.
- Other incisions may be made to introduce other small grasping, probing, or cutting tools.
- Injured tendons and muscles will be repaired or replaced with a graft tendon from another part of the body.
- Bone spurs (if present) will be removed.
- The incision(s) will be closed with stitches or surgical staples.
- A sterile bandage or dressing will be applied.