Rotator Cuff Repair
The rotator cuff originates from the shoulder in four muscular tendons, the supraspinatus, infraspinatus, teres minor and subscapularis. The four tendons rotate the arm in space and form a cuff around the ball, similar to a shirt cuff around a wrist. When the rotator cuff is injured pain is usually on the lateral aspect (outside) of the shoulder and occasionally in the front if the biceps is involved. The pain will often radiate down the arm to the elbow as well as toward the shoulder blade. Pain is often made worse with elevation of the arm to the front or to the side as well as rotation of the arm. These injuries may also be associated with damage to the biceps tendon, labrum and acromioclavicular joint. Rotator cuff tendon tears are described in detail on the Rotator Cuff Injury page for your review. Appropriate treatment for rotator cuff tears depends on many factors and not all rotator cuff tears need to be repaired. This depends on the patient’s age, health, functional demands placed on the shoulder and the type and size of the tear. If surgical repair is needed, treatment is done as an arthroscopic procedure.
The arthroscopic rotator cuff repair can be done at the hospital or an outpatient surgical center. Through very small incisions, Dr. Lenarz inserts small instruments into the shoulder including a camera. The entire shoulder is inspected under direct visualization with this camera and any damage that may not have been noted on an MRI will be addressed appropriately.
Surgery for rotator cuff tears is a simple arthroscopic procedure. This may include a reshaping of the acromion (shoulder blade) overlying the rotator cuff to eliminate any mechanical impingement (rubbing) of the rotator cuff and biceps. This is termed an acromioplasty and involves removal of “bone spurs” from the shoulder blade (acromion). When a rotator cuff tear is present this is usually repaired with arthroscopic techniques. Dr. Lenarz uses a Double Row technique to restore the torn tendon to the original “footprint” of the tendon insertion. This is typically performed as an outpatient surgery. The most difficult part of a rotator cuff repair for the patient is the period of recovery. The initial 3 months post-operatively is focused on range of motion only and Dr. Lenarz advises his patient’s to avoid all lifting pushing and pulling with the operative arm. Failure to follow these recommendations increases the risk of the tendon being pulled away from the footprint so it is unable to heal back to the bone. After this initial 3 month period the shoulder is gradually strengthened. It therefore may take 4 to 6 months for a person to return to their normal daily activities. In the situation of a massive rotator cuff tear or revisions rotator cuff repair this time period may be extended even longer.
After the surgery, the patient will wake in the recovery room in a sling. If a “nerve block” was performed by the anesthesia doctor before the operation the arm will remain numb for 12-24 hours. This is usually done for post-operative pain control. Icing the shoulder should be done liberally. This can be through the use of ice in a bag, ice packs or a circulating ice water cooler. The dressing may be removed and the patient may shower the day following surgery. The patient is asked to NOT scrub the incisions but allow water to wash over them. For standard rotator cuff repairs, the initial 4 weeks is restricted to passive motion only with the shoulder. The elbow, wrist and hand can be moved actively. The following 8 weeks are active and passive motion of the shoulder with no lifting, pushing, pulling or strengthening. These restrictions should be observed for the first 12 weeks post-operatively. After that period, strengthening of the shoulder will begin.