Mary Cate, BSN, RN, Cassy Loucks, PA, Brian Holloway, MD, Edwin Spencer, MD, Anita Davis, LPN, and Jeff Jarnagin, PA
The information contained below is designed to provide patients and physical therapists with basic information on common surgical procedures. This service should supplement the information provided at your patient consultation office visit.
The rotator cuff is a group of four tendons that help stabilize and move the shoulder. A tear of the rotator cuff can occur in many ways, and no two rotator cuff tears are the same. Treatment is based on many factors, including how long the tear has been present, size of the tear, activity level of the patient, and medical condition of the patient. Therefore, we tailor the treatment of the rotator cuff tear to each individual.
A rotator cuff tear can be suspected based on a patient’s history. Patients frequently complain of shoulder pain that wakes them from sleep. This pain is not usually felt in the shoulder blade or neck but in the upper arm area. Patients often have pain or difficulty with overhead activities, activities behind the back (such as fastening a bra), and activities away from the body (such as getting a gallon of milk out of the refrigerator). In severe cases the patient might be unable to reach overhead at all.
The diagnosis can also be suspected based on a physical examination performed by your physician. Other diagnoses can act like a rotator cuff tear, such as tendonitis and bursitis and even a frozen shoulder. This is why a physical examination is important and why your physician might order an MRI. An MRI is a special study that evaluates the shoulder without the use of X-rays. If ordered, this study will be reviewed with you so that you can see the rotator cuff for yourself.
The goal of the surgery is to repair the rotator cuff tendons back to the bone. We do most of these surgeries arthroscopically. However, if the tear is large or the tissue is questionable, your surgeon may elect to perform an open rotator cuff repair. Prior to surgery, the anesthesiologist will discuss an interscalene block with you. This is a regional anesthetic that numbs the shoulder and provides good postoperative pain relief. The physicians will review the risks and benefits with you in detail.
An arthroscopic rotator cuff repair is an outpatient procedure. The repair is performed through small portals. Anchors, which are small screws that are placed in the bone, have sutures attached to them. The sutures are passed through the rotator cuff tendons and then tied down, securing the rotator cuff back to the bone.
An open rotator cuff repair is reserved for large tears when extra fixation is necessary.
The rehabilitation is basically the same for open and arthroscopic rotator cuff repairs. For the first six to eight weeks, the arm is held in a sling. The goal of the first six to eight weeks of therapy is to get the shoulder moving (to prevent stiffness), but not moving under its own power. This is accomplished with pendulum exercises performed at home and passive range of motion exercises performed with a physical therapist or other assistant. It is important that you as a patient remain relaxed so that the therapist or assistant can move your shoulder for you. This may require pain medication prior to your therapy. Heat applied to the shoulder prior to therapy may allow more motion, and ice (ice pack or Cryo/Cuff) after may help with pain and swelling. The therapy is based on protocols depending on the size of your tear. You will be given a prescription for your specific therapy protocol.
Waist-level activities such as eating and even preparing food can be performed postoperatively. The most important thing to remember is that the elbow cannot be raised away from the body. Such activity uses the rotator cuff and could cause it to tear again. Therefore, it is important to wear the sling at night and when away from home. While at home you may remove the sling, but you must be careful. When sleeping, place a pillow under the elbow to keep your forearm resting on your stomach.
You may shower after four days. The dressing should be removed, but the Steri-Strips (small strips on the wounds) should be left in place. Allow the water to flow over the wounds, but do not soak the area (no hot tub or bath). To wash the armpit, simply bend over at the waist and allow the arm to dangle down toward the floor. This exposes the armpit without danger to the repair. You may apply deodorant in the same fashion. Simply dry the area after showering and apply a dry dressing if desired.
Below are some X-rays of a rotator cuff repair.