Cuff Tear > Treatments
If the tear in your rotator cuff tear has affected less
than 40 percent of the cuff’s total thickness,
your surgeon may be able to use a procedure called arthroscopic
debridement, in which the damaged portion of the cuff
is excised. Debridement is usually done arthroscopically,
but this may vary depending on the surgeon.
The decisions you make and the actions
you take before surgery can be every bit as important
as the procedure itself in ensuring a healthy recovery.
sure you have received any equipment you will need when
you get home from the hospital. This may include a shoulder
sling, ice packs or coolers, or heating pads. You should
receive prescriptions for any of these from your doctor
when your surgery is scheduled.
the potential risks and benefits of the surgery by asking
your surgeon any questions that will help you better
understand the procedure. It can also help to talk to
someone else who has undergone the same surgery.
physical problems, such as a fever or infection, should
be reported to your surgeon, and you should notify your
surgeon of any medication you are taking.
the surgery is not being done arthroscopically, discontinue
use of any anti-inflammatory medicine, especially aspirin,
a week prior to surgery, to prevent excessive bleeding
during the surgical procedure.
a second opinion from a physician who is as qualified
as the surgeon who made the initial diagnosis is advisable
in any case.
check if the orthopedist performing the surgery is board-certified,
which can be determined by calling the American Board
of Orthopaedic Surgery at 919-929-7103.
At most medical centers, you will
go to "patient admissions" to check in for
your arthroscopic debridement. If your surgery is going
to be inpatient, there may be a separate department,
so be sure to ask your doctor. After you have checked
in to the hospital or clinic, you will go to a holding
area where the final preparations are made. The paperwork
is completed and your shoulder may be shaved, though
this is not always necessary. You will wear a hospital
gown and remove all of your jewelry. You will meet the
anesthesiologist or anesthetist (a nurse who has done
graduate training to provide anesthesia under the supervision
of an anesthesiologist). Then, you will walk or ride
on a stretcher to the operating room. Most patients
are not sedated until they go into the operating room.
Here are some important things to remember for the day
of your surgery:
will probably be told not to eat or drink anything after
midnight on the night before your surgery. This will
reduce the risk of vomiting while you are under anesthesia.
the anesthetic and pain medications may make you drowsy
and you will be unable to drive, arrange for someone
to help take you out of the hospital and drive you home
when you are released.
a soft, comfortable shirt that will not irritate your
skin when worn under a shoulder sling.
it easy. Keeping a good frame of mind can help ease
any nerves or anxiety about undergoing surgery. Distractions
such as reading, watching television, chatting with
visitors, or talking on the telephone can also help.
Arthroscopic debridement of a rotator
cuff tear typically takes one to two hours to perform.
will either be put under general anesthesia or have
your arm numbed with a regional anesthesia that is injected
into your shoulder. The more tendons you have damaged,
the longer the surgery will take to perform and the
longer you will have to be under anesthetic.
arthroscope (a tiny camera about 3 1/2 millimeters in
diameter) is inserted into your shoulder, and provides
images on television monitors so the surgeon can see
your shoulder ligaments.
instruments are inserted through two or three incisions
about three to four millimeters wide.
thickness tears usually have frayed or rough fragments
removed (debrided). Surgeons then stimulate bleeding
in the injured area to promote healing.
edges on the top of the shoulder blade (acromion) may
be pinching the rotator cuff. This may require the flattening
of these bones, a procedure called subacromial decompression.
surgery you will receive stitches and be taken to the
recovery room. The stitches are usually removed in two
to three weeks.
When you awaken in the recovery room
following arthroscopic debridement, your shoulder usually
is wrapped in gauze, immobilized in a sling, and covered
with an ice pack. You may feel a moderate amount of
pain, depending on the severity of the rotator cuff
tear. You usually stay in the recovery room for at least
two hours while the anesthetic wears off. General anesthesia
wears off in about an hour and regional anesthesia may
take about two hours to wear off. You will be given
adequate pain medicine, either orally or through an
IV (intravenous) line, as well as instructions for what
to do over the next couple of days. In addition, you
will be given an appointment to return in two to three
weeks and a prescription for pain medicine. You should
try to move your fingers while you are in the recovery
room to improve circulation. Moving your wrist may be
painful and you usually should not try to move your
elbow. Your temperature, blood pressure, and heartbeat
will be monitored by a nurse, who, with the assistance
of the doctor, will determine when you are ready to
leave the hospital or, if necessary, be admitted for
an overnight stay. The majority of patients leave the
hospital after two or three hours. As soon as you are
fully awakened, you usually are allowed to go home.
You will be unable to drive a car, so be sure to have
arranged a ride home.
After arthroscopic debridement for
a rotator cuff tear, you will need to take steps to
reduce the pain and inflammation in the shoulder. Rest,
icing, and anti-inflammatory painkillers such as ibuprofen
or aspirin can ease pain and swelling. Immobilizing
the shoulder in a sling for two or three days will help
keep it stabilized. Larger tears may require you to
wear the sling for a few weeks. Here is what you can
expect and how you can cope with a sling immobilizing
first concern is to monitor swelling for the first 48
hours while wearing your sling. Physicians generally
prescribe ice packs to be applied for 15 to 20 minutes
at a time, three or four times a day.
the swelling has decreased during the first three days,
you may be able to apply heat to help reduce pain. You
should not apply heat to swollen areas because heat
increases blood flow to the skin, which can prolong
the healing process.
generally recommend that you wear the shoulder sling
day and night for about two or three days for partial
tears and up to three weeks for complete tears.
can usually remove the gauze bandage and bathe regularly
after two days. If surgeons had to make a 1 1/2-inch
"mini-incision" to suture your rotator cuff
tear, you may have to keep the bandage on and sponge
bathe for about seven days. You can take your sling
off for brief periods while you bath, but remember to
avoid moving your injured shoulder.
bleeding and fluid drainage is normal during the first
two days. Call your physician if bleeding continues.
your shoulder starts to heal, your physician may recommend
that you remove the sling for short periods to perform
some light, early-motion exercises.
should move your fingers and hands in the sling as much
as possible to help circulate blood.
you develop a rash or irritated skin around your sling,
call your physician.
you notice any abnormal wear or discomfort in the sling,
contact your physician as early as possible. In general,
do not try to "grin and bear it" if discomfort
does not go away within a few days. Slings should not
irritate your skin.
may feel some stiffness in your shoulder. If the stiffness
does not ease after two or three days, call your doctor.
The sling may make it difficult to use the hand of
the injured shoulder. Some people may need to take two
or three weeks off from work after a complete rotator
cuff tear, depending on how much they rely on the immobilized
To prevent stiffness, passive motion
exercises usually can start as soon as possible after
rotator cuff surgery with the aid of a physical therapist.
However, your physician may recommend that you rest
for between one to two weeks, depending on the severity
of your injury and your involvement in physical activities.
Physical therapy for rotator cuff tears usually progresses
through four phases. The time you spend in each phase
depends on the severity of your injury and your body’s
ability to heal.
first phase focuses on decreasing inflammation in the
rotator cuff. Your therapist usually helps you move
your arm and stretch your shoulder.
you feel comfortable moving your arm with your own strength,
the second phase of rehabilitation works on restoring
a full range of motion and strengthening the hands,
wrist, and elbow.
muscles and tendons in the rotator cuff have healed,
the third phase of rehab strengthens the rotator cuff
muscles. You usually learn shoulder-strengthening exercises
without weights and progressively add resistance as
pain goes away.
the muscles in the injured rotator cuff are about as
strong as the uninjured muscles, phase four of rehabilitation
becomes more activity oriented. You usually perform
sport specific exercises and coordination drills under
the supervision of a therapist or coach.
injury rehabilitation exercises: Rotator cuff tear
The best way to prevent recurring
rotator cuff tears is to make the strengthening exercises
you learned in rehabilitation part of your everyday
routine. You should remember to stretch your shoulder
and warm up before exercising. Sports that involve repeated
overhead motion, like baseball and tennis, inevitably
strain your shoulder. To prevent injury, you need to
keep all the rotator cuff muscles toned and flexible
with an exercise program. You also may need to alter
your work environment to avoid repeated overhead activities.
Physicians generally recommend that you ice your shoulder
after activities. Competitive athletes may need to use
anti-inflammatory medication, like aspirin and ibuprofen,
after sports activities that cause swelling in their
shoulders. Physicians generally recommend that if you
feel pain in your shoulder after a rotator cuff tear,
you should cut back your activity level and return to
your physician for a check-up.