Surgery may be used to treat a rotator cuff disorder if the injury is very severe or if nonsurgical treatment has failed to improve shoulder strength and movement sufficiently.

Pain in the shoulder may occur for many reasons. A tear in the rotator cuff is the most common cause. The rotator cuff is made up of four muscles and their tendons which allow you to move your arm away from your body.

A tear in this group of muscles is commonly accompanied by pain when in motion and also at night. Weakness of the arm may occur if the condition is allowed to deteriorate. At this stage, you may be unable to move your arm away from your body. The muscles around the shoulder may atrophy or waste away until visibly notable in your shoulder.

Rotator Cuff Surgery Candidates

An Arthroscopic Rotator Cuff Repair is a minimally invasive procedure that preserves the deltoid attachment and results in improved patient outcomes and faster recovery time than conventional surgery.

Persons who have tears to the rotator cuff tendon that don't respond to treatment are candidates for surgery. Surgery is usually needed if there is a complete tear in the tendon. A complete tear results in a person being unable to raise the arm. Surgery may also be needed for a partial tear of the tendon, if the tear causes continued pain and weakness. In a complete tear, repair is usually done within 3 months of the injury.

There are two typical types of people who suffer from a rotator cuff tear. Younger, athletic people often have an injury that tears the rotator cuff. Middle-aged or elderly people usually have repeated stress of the shoulder muscles over time that eventually causes the tendon to tear.

The most common symptoms of rotator cuff injuries are pain and weakness in the damaged shoulder. Sometimes a person feels pain only when using the shoulder; for example, to reach for an object or to lift something overhead.

If the rotator cuff is torn completely, though, the pain can be constant. A person with a completely torn rotator cuff may not be able to lift the arm from the side of his or her body.

People with rotator cuff injuries often experience pain at night because sleeping in certain positions puts pressure on the shoulder. In some people, the injured shoulder makes popping or clicking sounds when moved. For others, the shoulder seems to stick momentarily.

Rotator Cuff Surgery Alternatives

Nonsurgical treatment typically involves activity modification (avoidance of activities that cause symptoms). Nonsurgical management of a rotator cuff tear can provide relief in approximately 50% of patients.

Treatment of inflammation of the rotator cuff begins with an accurate diagnosis to rule out a tear of the cuff, followed by a combination of anti-inflammatory and strengthening maneuvers. An anti-inflammatory agent such as ibuprofen or aspirin is ingested daily and continued for six weeks. Regular dosing is required to build up blood level and to maintain that level throughout the initial treatment time to obtain the optimum anti-inflammatory effect. By diminishing the inflammation, further strengthening and stretching exercises can be performed.

Rotator Cuff Surgery Outcome & Benifits

The advantages of arthroscopic surgery are smaller incisions, less disturbance of the normal shoulder musculature, and most likely less pain following surgery. Smaller incisions are cosmetically more appealing from a pain standpoint. A smaller incision causes less pain in the shoulder joint following surgery. The approach is less invasive and does not require splitting muscle layers in the same way that the traditional approach did. As a result the pain caused by splitting the muscle layers is decreased. The recovery time from the rotator cuff surgery is the same because it still takes the same amount of time for the tendon to heal back to the bone. But the advantages of arthroscopy are significant and have led to a lot of changes in the way we treat rotator cuff problems.

After rotator cuff repair, 80% to 95% of patients achieve a satisfactory result, defined as adequate pain relief, restoration or improvement of function, improvement in range of motion, and patient satisfaction with the procedure.

Surgical techniques for rotator cuff repair have progressed to more minimally invasive procedures. With each advance in technique, surgeons experience a learning curve to master the new technique. Initially, some tears were considered too large to be treated with less invasive techniques. As surgeons become more experienced in using less invasive techniques, they are better able to treat most tears with less invasive means. The most recent development is the all-arthroscopic technique.

Each step toward less invasive surgery has benefited the patient by:

1. Decreasing pain from surgery
2. Decreasing postoperative stiffness
3. Decreasing surgical blood loss
4. Decreasing length of stay in the hospital

Each technique has similar results in terms of satisfactory relief of pain, improvement in function, and patient satisfaction. Less invasive surgery results in an easier rehabilitation process and less postoperative pain.

Prepare for Rotator Cuff Surgery

The orthopaedic evaluation of your shoulder consists of three components:

• A medical history to gather information about current complaints; duration of symptoms, pain and limitations; injuries; and past treatment with medications or surgery.
• A physical examination to assess swelling, tenderness, range of motion, strength or weakness, instability, and/or deformity of the shoulder.
• Diagnostic tests, such as X-rays taken with the shoulder in various positions. Magnetic resonance imaging (MRI) may be helpful in assessing soft tissues in the shoulder. Computed tomography (CT) scan may be used to evaluate the bony parts of the shoulder.

Your orthopaedic surgeon will review the results of your evaluation with you and discuss the best treatment. You and your doctor may agree that surgery is the best treatment option. He or she will explain the potential risks and complications that may occur. Your doctor may discuss donating your own blood to be used if needed during surgery.

Some surgical procedures require hospitalization for a number of days. Your doctor may discuss planning for the period after surgery. You may need to either stay in an extended care facility or have someone help you when you return home.

• No food or drink after midnight before surgery.
• Discuss with your doctor what to do about medications taken in the morning.
• An hour before surgery, you will be assessed in the preoperative area by a nurse anesthetist or anesthesiologist.
  

Rotator Cuff Surgery Overview

During rotator cuff surgery, the patient is put in a half-sitting position, with the head supported. Most operations are performed under general anesthesia, where the patient is asleep. Sometimes a regional (or local) anesthetic is used to block the nerves leading to the arm. In that case, the patient is conscious but cannot feel pain. Usually a sedative is also given, putting the patient in a conscious but dreamy state.

Rotator cuff surgery usually takes one to two hours.

Types of procedures include:

• Impingement surgery
• Rotator cuff repair
• Arthroscopic surgery

Impingement Surgery

Impingement Surgery is also Called Acromioplasty Or Subacromial Decompression. If the space between the upper arm and the part of the shoulder blade known as the acromion is too narrow, the rotator cuff cannot move freely. Rotator cuff tendons get pinched between the two bones, gradually damaging the rotator cuff.

To resolve this problem, the surgeon shaves a small portion of bone from the underside of the acromion, giving the tendons more room to move and preventing them from being pinched. The surgeon also removes any bone spurs and either excises or removes swollen or irritated bursa.

Impingement surgery is sometimes performed to relieve severe, chronic tendinitis that does not respond to nonsurgical treatment. Impingement surgery is also done as part of most rotator cuff repair surgeries.

Rotator Cuff Repair

In order to repair a torn rotator cuff, the surgeon reattaches the damaged tendon (or tendons) to the upper arm (humerus). (Some rotator cuff injuries involve more than one torn tendon.)

This surgery involves several key steps:

• In order to gain access to the injured rotator cuff, the surgeon makes a two- to three-inch incision in the shoulder, then cuts through the deltoid muscle.
• The surgeon removes any scar tissue that has built up on the tendon.
• The surgeon carves a small trough at the top of the upper arm, then drills small holes through the bone.
• Finally, the surgeon sews the tendon to the bone, with the sutures going through the tiny holes in the upper arm. (Sometimes a surgeon will use permanent anchors to attach the tendon to bone.)

During this operation, the surgeon also removes bone spurs and releases any ligaments that are pressing on the tendon. If a bursa is inflamed, the surgeon excises or removes it. The surgeon also may remove a small portion of the acromion to make sure the repaired rotator cuff has enough room to move.

Afterwards, the patient's arm is placed in a sling. With time, healing occurs, as scar tissue connects the tendon to bone. Because tendons receive such poor blood supply, this is a slow process.
Arthroscopic Surgery

Arthroscopic surgery is a technique for performing an operation using pen-shaped instruments with a miniature video camera attached to the end.

• The surgeon makes a small incision in the shoulder about the size of a buttonhole.
• He or she then inserts the thin tube that contains the tiny video camera and surgical instruments.
• The surgeon performs the operation with these remotely controlled instruments while watching on a video screen.

Because arthroscopic surgery requires only limited surgical access, the incision is much smaller than is necessary for open surgery, resulting in fewer risks. The patient's recovery time is also shorter.

However, because repairing a torn rotator cuff can be a complicated procedure, it is often performed as an open procedure. However, arthroscopic repairs are becoming more common, especially for small size tears.

Rotator Cuff Surgery Recovery

A successful ankle replacement will get rid of your pain and allow you to move your ankle to up and down. Usually, total ankle replacements last 10 or more years. How long yours lasts will depend on your activity level, overall health, and the amount of damage to your ankle joint before surgery.

After surgery, you will need to stay in the hospital for up to 4 days. When your surgery is complete, your leg will be elevated and your ankle immobilized in a splint.

A small tube that helps drain blood from the ankle joint will be left in your ankle for 1 or 2 days. To keep swelling down, you can keep your foot raised higher than your heart while you are sleeping or resting.

Your doctor may recommend physical therapy to learn exercises that will help with ankle motion.

Rotator Cuff Surgery After Care

After surgery, the patient is taken to a recovery room for an hour or two. The injured arm is kept in a sling, often with a pillow behind the elbow.

Patients initially drink only clear liquids before eating regular food. Ice is applied to the shoulder for comfort.

Patients are encouraged to get out of bed with the arm in a sling. The sling can usually be released but not removed, allowing the elbow to straighten without moving the shoulder.

Patients who had open surgery usually stay in the hospital for a day or two. Patients who had arthroscopic surgery can often return home on the same day.

When You Return Home

Physical therapy plays an extremely important role in the recovery process. A physical therapist teaches the patient exercises designed to help regain flexibility and strength in the injured shoulder.

Most patients begin physical therapy before leaving the hospital. The physical therapist is an educator. The therapist's role is to teach the patient appropriate exercises that can be done safely at home to speed the recovery process. He or she will also teach the patient how to avoid re-injuring the surgically repaired rotator cuff.

Because physical therapy can be difficult and physically demanding, therapists usually like to meet with members of the patient's family in the hospital so they can learn to help the patient with physical therapy at home.

Rotator Cuff Surgery Possible Risks

There are always some risks with any surgery, even arthroscopic procedures. These include possible infection, and damage to surrounding nerves and blood vessels. However, modern surgical techniques and close monitoring have significantly minimized the occurrence of these problems.

After surgery, some pain, tenderness, and stiffness are normal. You should be alert for certain signs and symptoms that may suggest the development of complications.

• Fever after the second day following surgery
• Increasing pain or swelling
• Redness, warmth, or tenderness which may suggest a wound infection
• Unusual bleeding (some surgical wound drainage is normal and, in fact, desirable
• Numbness or tingling of the arm or hand