Rotator Cuff Surgery

What is the rotator cuff?

Your shoulder is a ball and socket joint that has great mobility. The rotator cuff is a group of four tendons that attach to the ball and helps move your arm and stabilize the joint by keeping the ball firmly centered on the socket. This tough tendon tissue supports shoulder joint mobility, allowing you to lift and rotate your arm.

What is a rotator cuff tendon tear?

Rotator cuff tears can occur after an acute (new) injury such as a fall or due to the degenerative changes that occur over time, making the tough tendon more vulnerable to tears. A rotator cuff tear indicates that one or more of the tendons are no longer fully attached to your arm bone. You may experience pain that keeps you up at night, have difficulty lifting objects, have difficulty dressing, weakness, and stiffness. Following a new injury, you may feel severe pain and an inability to raise your arm.

How is a rotator cuff tear diagnosed?

Dr. Cleeman diagnoses a rotator cuff tendon tear during an evaluation of your shoulder. Physical examination usually reveals pain with motion and weakness. To confirm the diagnosis and assess the severity of your rotator cuff tear, diagnostic imaging including X-ray and Ultrasound are performed in the office. The Ultrasound can visualize a rotator cuff tendon tear. MRI imaging may also be obtained to confirm the tear prior to surgery. Results of these tests are reviewed with the patient and a personalized treatment plan to return the patient to their prior activity level and function is implemented.

What are my treatment options for a rotator cuff tendon tear?

If not properly treated, your rotator cuff tear can worsen and lead to chronic shoulder pain. In many people, rotator cuff pain from degenerative tearing can improve with nonsurgical treatments, such as medication, injections, and physical therapy.

However, if you suffered a traumatic tear or continue to experience pain after active participation in your nonsurgical program, then Dr. Cleeman may recommend surgery. Other reasons you may benefit from rotator cuff surgery include:

• Your tear is acute from an injury
• You’ve experienced symptoms for 6-12 months
• You have little function in your shoulder
• You have a large tear
• You need your shoulder for work or sports

Dr. Cleeman is an experienced orthopedic surgeon who reviews all of your options during a consultation.

What is rotator cuff tendon repair surgery?

Dr. Cleeman performs rotator cuff surgery with a minimally invasive technique called arthroscopy. During the procedure Dr. Cleeman inserts a surgical camera through a tiny incision (portal) in your shoulder to evaluate the rotator cuff and other structures in the shoulder. He then creates 3 additional tiny incisions for the surgical instruments to repair the tear. The torn edge of tendon is cleaned and smoothed. Sutures are then used to re-attach the torn tendon edge back to the arm bone.

Superior capsule reconstruction and reverse shoulder replacement versus rotator cuff tendon repair

In some patients a chronic degenerative rotator cuff tear can become so large, retracted, and atrophied that it is no longer repairable. If pain and loss of function persist despite non-surgical management, there are alternative surgical options.

• A patch of donated tissue can be sewn in arthroscopically to substitute for the missing tendon, this is called a Superior Capsule Reconstruction. This procedure helps stabilize the shoulder, reduce pain, and improve function.
• Another surgical option is to replace the shoulder with artificial components that use altered mechanics to improve arm function and reduce pain, this procedure is called Reverse Shoulder Replacement. This procedure is not arthroscopic.

What should I do prior to surgery?

• Following an acute traumatic tear many patients will have pain and be unable to lift the arm. Once the diagnosis is confirmed we recommend having surgery relatively soon, to avoid further tendon retraction, scar tissue build up or stiffness.
• For those patients with chronic tears that developed slowly over time, we often recommend a course of physical therapy.
• Some patients have stiffness that may benefit from physical therapy prior to surgery.

What will my day of surgery be like?

Once you have checked in you will meet your nurse and the medical team. If necessary, we will shave the hair around the shoulder. You will receive an IV through which to receive medication including anesthesia and antibiotics. Most patients will have an anesthetic injection to numb their shoulder and arm and general anesthesia. Surgery typically lasts 1-2 hours depending on the size and number of tendons torn. After surgery you will spend approximately 1-2 hours in the recovery room prior to going home. Dr. Cleeman prescribes medication to help manage pain following your procedure.

Where will my surgery be performed?

Rotator cuff tendon repair is an ambulatory procedure, meaning you will go home the same day. Please remember to arrange for someone to accompany you home. Dr. Cleeman performs Rotator cuff surgery at an Ambulatory Surgical Center (ASC). There are several benefits to having rotator cuff surgery at the ASC.

• Approximately 50% reduced risk of infection in ASC compared to surgery in a hospital.
• Time spent by a patient in an ASC is close to 25% less than the time spent in a hospital for the same surgery.
• Procedures performed in ASCs take, on average, 30 fewer minutes than those performed in hospitals.
• Outpatient surgery centers can be 45-60% less expensive than hospitals.

How long is the recovery from rotator cuff repair tendon surgery?

Recovery from surgery goes through phases. During the initial first 6 weeks you will wear a sling and start a program of passive motion to help regain motion. This means that a physical therapist will gently move your arm for you. It is important that you do not actively use your own muscles to lift the arm during this phase to avoid stress to the repair, which can risk re-tear. This is followed by an active exercise motion program to improve joint mobility for another six weeks. During this phase you have discontinued the sling and move the shoulder and arm yourself.

After the initial 12 weeks Dr. Cleeman advances you to a more active exercise program to rebuild strength in your shoulder, arm, and upper back, for 3 months.

While the recovery is long, adherence to the plan created by Dr. Cleeman reduces pain, improves shoulder function, and reduces risk of a re-tear. 

What are the risks to rotator cuff tendon repair surgery?

Some sensitivity around the incisions is common and usually resolves over time. Depending on the study, reports indicate that some patients may re-tear their rotator cuff tendon in the future. This risk is more common in older adults and those with large, retracted tendon tears with muscle atrophy. Therefore, it’s important to address this condition when it is detected in younger and middle-aged adults. Complications after surgery are rare but may include (but are not limited to) tendon re-tear, stiffness, and infection.

• Following the post-surgical protocol including avoiding active shoulder motion during the first 6 weeks, wearing a sling during the first 6 weeks, and avoiding strength exercises during the first 12 weeks will help minimize the risk of a tendon re-tear.
• Physical therapy and maintaining a diligent home exercise therapy program minimizes risk of stiffness.
• Antibiotics given during surgery to help reduce risk of infection. If any problems arise after the procedure, please contact the physician immediately to help resolve the issue.

Will I be able to return to my normal activities after rotator cuff tendon repair surgery?

The goal of rotator cuff tendon surgery is to resolve pain, regain function and return you to an active lifestyle including exercise and sports. Most patients return to their prior level of activity which may include weightlifting, tennis, and golf. It usually takes 6 months to return to this level of activity. We encourage all our patients to remain physically active.

To consult with Dr Edmond Cleeman at Manhattan Orthopedics to discuss your rotator cuff surgery, call the office today or use the online booking tool.