Rotator Cuff Surgery

Most people who suffer a rotator cuff injury recover with conservative treatment, including rest, ice, pain medications, and steroid shots. This is especially true when the rotator cuff injury occurs over time due to progressive wear and tear. However, when a rotator cuff injury is severe, conservative treatment may not be enough. Surgery may be necessary to repair the damage. It is particularly important to seek prompt medical care for rotator cuff tears due to a single injury with immediate onset of symptoms. In such instances, rotator cuff surgery can repair the damage and prevent complications.

In this article, we take a deep dive into surgical treatment for rotator cuff injuries. We’ll describe the various types of procedures performed and the potential complications that can occur.

When is Rotator Cuff Surgery Necessary?

Your healthcare provider may recommend rotator cuff surgery if your symptoms of shoulder pain, weakness, and reduced range of motion do not get better with conservative (non-surgical) therapies. If you have an active lifestyle, and the rotator cuff injury is preventing you from playing sports or working, surgery could be indicated. In general, rotator cuff surgery is recommended when:

Symptoms have been present for greater than 3 months.
There is a significant pain and/or weakness of the shoulder and difficulty performing daily tasks.
Imaging studies (MRI scan) demonstrate a tear in one of the rotator cuff tendons, and the tendon tissue surrounding the tear is healthy.

Types of Rotator Cuff Surgery

Surgery for the repair of a rotator cuff injury consists of re-attaching a torn tendon to the upper arm bone. Partial tears in rotator cuff tendons can be fixed by trimming the tendon – this procedure is known as a debridement. However, complete rotator cuff tears require the surgeon to attach the torn tendon to the original location on the upper arm bone.

Surgeons use different types of procedures to repair the rotator cuff. Over time, advancements in surgical techniques have meant that minimally-invasive procedures are available for rotator cuff repair surgery most often do not require an overnight stay in the hospital.

Your surgeon will recommend the best rotator cuff surgery for you depending on the size of the tear, your shoulder anatomy, and the quality of the surrounding tissue. In the following paragraphs, we’ll describe the techniques commonly used for rotator cuff repair. The goal of each of these rotator cuff surgeries is to get the tendon to heal, provide pain relief, and improve strength and range of motion. However, each type of rotator cuff surgery has its advantages and disadvantages.

Options for Rotator Cuff Surgery

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Open Repair of Rotator Cuff Injuries

This type of surgery is used to repair large or complex rotator cuff tears. It is the traditional approach to rotator cuff surgery in which the surgeon makes a several centimeter long incision to gain access to the torn rotator cuff tendon. During an open rotator cuff surgery, the surgeon can also address other problems such as bone spurs on the acromion (the bony tip of the shoulder). Although open repair is still sometimes necessary, it is less commonly used nowadays. Newer surgical techniques have led to the development of less invasive procedures for rotator cuff surgery that offer faster recovery.

Arthroscopic Repair of Rotator Cuff Injuries

Shoulder arthroscopy is a procedure in which the surgeon inserts a tiny camera called an arthroscope into the joint. This allows the surgeon to view the internal structures of the rotator cuff on a TV screen. The surgeon then inserts small, thin surgical tools and instruments through very small incisions to repair the tendon. An arthroscopic rotator cuff surgery is the least invasive method of repairing a torn tendon.

Reinforcement with Graft

This type of rotator cuff surgery is utilized when a surgeon decides that the tendon would benefit from an addition of a graft (usually from a cadaver). The graft is anchored to the tendon and bone using very strong sutures to ensure everything is secured properly.

Suprascapsular Reconstruction

This type of rotator cuff surgery utilizes a graft from the superior glenoid to the greater tuberosity to stabilize the humeral head. This graft helps partially recreate the rotator cuff function.

Reverse Total Shoulder Replacement

In patients with a completely torn rotator cuff that is irreparable, a procedure called reverse total shoulder replacement may be offered. The procedure replaces the shoulder joint with an artificial device and relies on the deltoid muscle, instead of the rotator cuff muscles, to move the arm and shoulder.

Complications of Rotator Cuff Surgery

When performed by an experienced surgeon, rotator cuff surgery is safe and effective. However, a small number of patients experience complications from the surgery, including blood loss, infection, and risks associated with anesthesia. Potential complications of rotator cuff surgery include:

Stiffness – it is important to start rehabilitation early in the postoperative period to reduce the risk of shoulder stiffness and loss of range of motion.

Infection – your doctor will give antibiotics just prior to the start of the operation to reduce the risk of infection. However, if a joint infection develops, prolonged antibiotic therapy or additional surgery may be necessary.

Nerve injury – the nerve that supplies the deltoid muscle can sometimes get irritated or injured during open rotator cuff surgery.

Re-tear of the tendon – in people with large tears, there is a risk of tendon re-tear after rotator cuff surgery. Occasionally, repeat surgery may be needed.

The majority of patients experience a considerable reduction in pain and improvement in function after rotator cuff surgery. To ensure the best outcome from the surgery,

Rotator Cuff Surgery

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