Your rotator cuff consists of four muscles in your shoulder that allow you to move your arm away from your body. These muscles have tendons, which connect them to the head of your upper arm bone or humerus. When a tear occurs in these muscles, you will experience extreme pain on motion. A rotator cuff tear is also extremely painful at night. If left untreated, it may result in arm weakness.
Rotator cuff surgery may be required to repair and reattach torn tendons to the shoulder. This may be followed byrotator cuff exercises after surgery to promote further healing and return of function.
When Is Rotator Cuff Surgery Necessary?
A partial rotator cuff tear may not need surgery. Conservative treatment consists of rest and exercise, which help to heal your shoulder. This is recommended if you do not place a lot of stress on your shoulder. Pain is likely to improve, but your shoulder may become weak and the tear may enlarge over time, which may limit your activities.
- Rotator cuff surgery is necessary when you have extreme shoulder pain that does not improve with rest and other conservative treatments within 6 to 12 months. Pain at night may be intolerable and does not improve with exercise.
- Rotator cuff surgery is the best option when the rotator cuff tear is large or complete. Surgery may also be recommended for a tendon that is torn due to recent injury or when the tear is not a result of long-standing rotator cuff problems.
How to Prepare for the Rotator Cuff Surgery
To prepare for rotator cuff surgery, inform your doctor about the current treatments you are taking. Two weeks before the surgery, you may have to stop taking some medicines that can interfere with blood clotting such as aspirin, naproxen or ibuprofen. You will also have to see a doctor to evaluate your medical condition if you have any health problems such as diabetes or heart disease. Other factors that may affect your surgery are your smoking habits and alcohol intake, which you must avoid before surgery. Tell your doctor if you have any acute illness such as flu or fever before surgery.
On the day of surgery, avoid eating or drinking anything 6 to 12 hours before the operation. Just take a small sip of water to ingest any medication you are asked to take. Go to the hospital early so you will arrive on time for your surgery.
How Is Rotator Cuff Surgery Done?
There are different surgical options, but the goal of rotator cuff surgery is to help the tendons heal. However, just like other types of surgeries, there are some risks involved such as bleeding, injury to a nerve or blood vessel, and infection.
Open Repair
A large or complex rotator cuff tear may need open repair, which is the traditional technique that involves a large surgical incision over your shoulder. In this technique the deltoid muscle is detached for the surgeon to get better access to the involved tendons underneath. During the surgery, bone spurs may be removed and reconstruction of tendons may be done.
Open repair is an invasive technique for treating a rotator cuff tear. However, there are now newer technologies that are less invasive.
All-Arthroscopic Repair
This technique involves the use of an arthroscope or small camera that is attached to a thin instrument (arthroscope), which the surgeon inserts into the shoulder joint. This camera displays images on a screen or monitor and guides your surgeon to manipulate miniature instruments. It is the least invasive technique that involves very small cuts or incisions to your skin and can be done as an outpatient procedure.
Mini-Open Repair
This newer technology uses instruments to repair torn tendons through a small skin incision (only 3 to 5 cm). Arthroscopy is used to evaluate and repair damaged structures around the joint and remove bone spurs without detaching the deltoid muscle. When done, the rotator cuff is repaired through a mini-open incision while the surgeon views the structures directly, without using the video monitor.
Watch the video below to get a clearer demonstration of how a rotator cuff surgery is done:
Rotator Cuff Exercises After Surgery
Rehabilitation is important to help get you back to your usual activities. This involves a physical therapy program that includes rotator cuff exercises after surgery to improve the strength and movement of your shoulder. Rehabilitation consists of:
Immobilization
The repaired shoulder must be protected while your tendon heals by immobilizing your arm. You will use a sling to avoid arm movement for the first four to six weeks, depending on the severity of the injury.
Passive Exercise
The muscles around your shoulder will initially remain weak after rotator cuff surgery. Your surgeon will decide when is safe for you to start moving your shoulder and arm. A therapist will assist you in doing passive exercises that will help improve your shoulder’s range of motion. This involves supporting your arm while moving it in various positions. Passive exercises are usually begun within four to six weeks after rotator cuff surgery.
Active Exercise
After four to six weeks, you will start doing active exercises by yourself. This will gradually improve your shoulder and arm strength and control. Starting on the 8th to 12th weeks, your therapist will recommend strengthening exercises.
Complete recovery is expected only after several months. Many patients regain adequate range of motion and strength by four to six months after their surgery. This may be a slow process, but your commitment to complete rehabilitation is important for a successful outcome.