Rotator Cuff Injury and Repair

Your shoulder’s rotator cuff is the junction of tendons from four muscles, forming a protective cover around the head of the humerus (upper arm bone). The rotator cuff muscles are critical in both movement and stability of your shoulder joint, enabling your shoulder to rotate and your arm to move fluidly. Rotator cuff injuries happen in one of two ways: suddenly (accident or fall) or gradual (degeneration, repetitive activities, aging).

Rotator Cuff Tear & Tendinitis

Repetitive motions and stress can lead to tendonitis or tearing of the rotator cuff (and tendonitis alone can eventually weaken to the point of tearing). People who are susceptible include those with jobs that require frequent overhead motions using the shoulder, or participants of athletics like tennis and volleyball. Rotator cuff tearing can also be caused by trauma from falling on your arm, heavy lifting, or a dislocated shoulder.

A rotator cuff tear and rotator cuff tendonitis have similar symptoms, including:

• Pain in the front or outside of your shoulder, or down your arm, particularly when you raise your arms
• Stiffness
• Decreased range of motion
• Weakness

Diagnosis

Your doctor may be able to diagnose your rotator cuff injury through a detailed review of your medical history, plus a thorough physical exam. Sometimes diagnostic imaging – like an X-Ray, ultrasound scan, or MRI—is used to confirm the injury and assess its severity.

Treatments

If you are diagnosed with rotator cuff tendonitis, your doctor may prescribe one or all of the following treatments:

• Rest
• Non-steroidal anti-inflammatory drugs (NSAIDs) if needed
• Corticosteroid injections if needed
• Physical therapy as a standard treatment to help you regain your range of motion and shoulder strength

Rotator Cuff Surgery

If you are diagnosed with a rotator cuff tear and non-surgical treatment has not worked, you may need surgery. Most tears can be repaired by arthroscopic surgery, with a very small incision and, usually, an excellent outcome. Open surgery is still an option for complex cases. A number of repairs can be made during rotator cuff surgery. If bone spurs are causing shoulder pain, they can be shaved off. Torn tendons or muscles can be repaired, which usually entails tendon reattachment to the humerus head. After rotator cuff surgery, you should have a renewed level of flexibility and functionality in your shoulder, without pain.

Before Rotator Cuff Surgery

• You will meet with your doctor to discuss the surgery and your health history and issues.
• You will sign a form consenting to the procedure.
• You will fast before the surgery, according to the instructions provided by your care team. Additional preparations may be needed according to your specific medical condition.

What to Expect During Rotator Cuff Surgery

Your surgery will be performed while you are under anesthesia. Your doctor may elect either general anesthesia where you are asleep or local anesthesia where you will be awake during the procedure. Rotator cuff repair surgery will typically entail the following process:

• After changing into a gown, an intravenous line will be initiated to administer fluids and possibly anesthesia.
• Your anesthesiologist will begin monitoring your heart rate, breathing, blood pressure, and blood oxygen level and will continue to do so throughout the surgery.
• The skin at the surgical site will be sterilized and the incision will be made.
• Your surgeon will repair or replace injured tendons and muscles, and/or if you have bone spurs, they will be removed.
• Your incision will be closed using stitches or surgical staples and sterile bandaging will be applied over the surgical site.

After Rotator Cuff Surgery

• In the recovery room, your circulation will be monitored.
• Once you’ve woken up, you will be taken to your hospital room or discharged provided your blood pressure, pulse, and breathing are stable.
• You can resume your regular diet.
• Follow all post-surgery instructions on physical activities and driving.
• You will probably use an immobilizer or sling for weeks to months after the surgery.
• Once home, you will take care of your surgical site by following the post-surgical instructions provided by your doctor.
• At a follow-up visit your stitches or surgical staples will be removed.
• You will be able to use at-home treatments (as recommended by your doctor) to relieve pain or swelling, including:
  • NSAIDs
  • Ice
• Wear your sling or immobilizer as directed.
• Complete a physical therapy program (four to six months).
• Report any of the following to your doctor: increasing incision-site pain, numbness or tingling, signs of infection, fever or chills.