Cuff Tear > Treatments
Partial and complete rotator cuff tears often
require surgery to sew the damaged tendons back together.
The sooner after the injury you visit your doctor and
undergo surgery, the faster you can return to activities.
Most surgical tendon repair in the rotator cuff can
be done with an arthroscope, which requires only a few
tiny three- to four-millimeter incisions. Large tears,
which are less common, may require an open incision,
but the procedure is similar to arthroscopic surgery.
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.
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 surgeon who is as qualified
as the surgeon who gave the initial diagnosis is advisable
in any case.
sure 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 surgical tendon repair. 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 anesthesia and pain medications may make you drowsy
and unable to drive, arrange for someone to help take
you out of the hospital and drive you home when you
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.
You will be given either regional
or general anesthesia as required by the complexity
of your injury. The more tendons you have damaged, the
longer the surgery will take to perform and the longer
you will have to be under anesthetic. The procedure
typically takes 1 1/2 to three hours to perform.
arthroscopic surgery, an 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. Microsurgery
instruments are then inserted through two or three incisions
about three to four millimeters wide.
the tear is large enough, surgeons occasionally have
to make a "mini-incision" of about an inch
and a half to access the tear for suturing.
either case, partial thickness tears usually have frayed
or rough fragments removed. Surgeons then stimulate
bleeding in the injured area to promote healing.
complete tears, surgeons suture the edges of the tear
together. These interior sutures dissolve in four to
problems in the shoulder, such as bone fragments or
chips, often are removed at the same time.
edges on the top of the shoulder blade (acromion) may
be pinching the rotator cuff, requiring surgeons to
flatten rough shoulder bones if necessary. This procedure
is 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 surgical tendon repair, 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 surgical tendon repair of a
torn rotator cuff, 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 two
days 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 after 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
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 for 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. Call your
doctor if the stiffness does not ease after two or three
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 arm.
With the aid of a physical therapist,
passive motion exercises usually can start as soon as
possible after rotator cuff injuries. Rehabilitation
can sometimes begin the day after a minor rotator cuff
tear. 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