Shoulder > Rotator Cuff Tear > Treatments

   Surgical Tendon Repair

Treatment Introduction

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.

   Make 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.

   Learn 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.

   Any 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.

   Discontinue use of any anti-inflammatory medicine, especially aspirin, a week prior to surgery, to prevent excessive bleeding during the surgical procedure.

   Getting a second opinion from a surgeon who is as qualified as the surgeon who gave the initial diagnosis is advisable in any case.

   Make 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:

   You 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.

   Because 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 are released.

   Wear a soft, comfortable shirt that will not irritate your skin when worn under a shoulder sling.

   Take 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.

   For 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.

   If 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.

   In either case, partial thickness tears usually have frayed or rough fragments removed. Surgeons then stimulate bleeding in the injured area to promote healing.

   For complete tears, surgeons suture the edges of the tear together. These interior sutures dissolve in four to six months.

   Other problems in the shoulder, such as bone fragments or chips, often are removed at the same time.

   Hooked 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.

   After 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 your shoulder:

   The 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.

   If 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 process.

   Physicians 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.

   You 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.

   Some bleeding and fluid drainage is normal for the first two days. Call your physician if bleeding continues.

   When your shoulder starts to heal, your physician may recommend that you remove the sling for short periods to perform some light, early-motion exercises.

   You should move your fingers and hands in the sling as much as possible to help circulate blood.

   If you develop a rash or irritated skin around your sling, call your physician.

   If 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.

   You may feel some stiffness in your shoulder. Call your doctor if the stiffness does not ease after two or three days.

   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 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.

   The first phase focuses on decreasing inflammation in the rotator cuff. Your therapist usually helps you move your arm and stretch your shoulder.

   When 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.

   When 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.

   When 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.

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