The shoulder joint is a ball and socket type joint. The rotator cuff is the group of 4 muscles that helps stabilize the ball in the socket as the joint moves through a wide range of motion. Falling onto the shoulder or onto the outstretched hand may tear the rotator cuff. Repeated overhead activity, such as throwing or swimming, may also tear the rotator cuff.
A torn rotator cuff commonly causes weakness and pain in the shoulder, although some patients with known tears of the rotator cuff have surprisingly few symptoms. Sometimes tears in the rotator cuff need to be surgically repaired. Surgery will usually be recommended if the tear is large, if the patient is young and very active or if the tear causes continued weakness or pain.
Your surgeon may or may not decide to look inside your shoulder with an arthroscope before doing the actual cuff repair. Arthroscopy sometimes helps evaluate the inside of the joint and can occasionally be used to clean out loose debris that may be present. Sometimes arthroscopy is not needed and the surgeon may proceed directly with the repair.
Rotator cuff tears are usually fixed by making an incision (approximately 1½-2 inches) over the outside of the shoulder. The tears in the cuff are then identified, and the torn edges are sutured together or reattached to bone. This may require the placement of drill holes, small screws or other anchors into the bone. These anchors may be made of metal or a type of material that will dissolve over time. Sometimes the tear is so large or the tissue so damaged that it is impossible to completely fix. Bone from the acromion at the tip of the shoulder and the underside of the clavicle (collar bone) is often shaved and removed to help reduce the pain after surgery.
Some cuff tears can be fixed arthroscopically and do not require an open incision. Your surgeon will determine this.
The surgery can often be done without a stay at the hospital and will take about 2 hours.
The incision from the surgery will be closed with stitches or staples and be covered by a sterile bandage. You may have some swelling and small bruises on your shoulder, but this should disappear within a few days.
For several weeks after your surgery, your arm will be placed into a sling or harness that will immobilize the affected arm. Sometimes it is necessary to place a pillow or brace under the arm for added support for several weeks.
It will take about 12 weeks for the tendon to heal completely. The early recovery phase lasts approximately 6 weeks. During the first 4-6 weeks you can and should use your hand, wrist, and elbow, but you should not lift the shoulder with its own muscle until instructed to do so by your doctor or therapist. Using the rotator cuff muscles too soon may cause the repair to fail.
Using the shoulder muscles for activities such as elevating the arm usually starts at about 4-6 weeks after surgery. A couple of weeks after your surgery, your doctor will have you return to have your stitches removed. At that time, your doctor may have you begin an assisted physical therapy program to help you regain your strength and range of motion. Full recovery from your surgery will take 6-8 months.