Arthroscopic rotator cuff repair for rotator cuff tears
Shoulder rotator cuff tears are a painful condition that leads to dysfunction of the shoulder.
Reviewed February 23, 2015, by Dr. Seneviratne
Symptoms
Shoulder pain and dysfunction — the inability to use the shoulder — are the hallmarks of a rotator cuff tear. The shoulder will be painful, and will have markedly limited range of motion. Patients frequently report pain at night, and activities of daily living become difficult.
Why it happens
The rotator cuff is a group of four tendons that coalesce to form a cuff around the shoulder joint. The four muscles are the subscapularis at the front of the shoulder, the supraspinatus on top, and the infraspinatus and teres minor at the back. The most commonly torn tendon is the supraspinatus.
Tears can happen from trauma, such as a fall, or gradually from degeneration of the tendon or an external bone spur. They are most common in patients in their 60s and above; younger patients can tear a rotator cuff too, but it is usually traumatic. A rotator cuff tear does not heal on its own — left untreated, the natural history is for it to get larger, and the muscle can atrophy and develop fatty infiltration, which is irreversible and can lead to a form of arthritis called rotator cuff tear arthropathy. Treatment options at that stage are limited, and can include reverse shoulder replacement.
How it is diagnosed
Diagnosis starts with a detailed history and a thorough physical examination. X-rays are usually the first imaging obtained. An MRI is used to visualize the soft-tissue damage directly.
Treatment
Small tears can be treated non-operatively if the patient becomes symptom-free with physical therapy and a home exercise program.
Dr. Seneviratne treats the large majority of rotator cuff tears with arthroscopic repair — a small camera is inserted through keyhole incisions, and the torn tendon is repaired back down to the bone using suture anchors. There are two repair techniques, double row and single row, both with good to excellent results; Dr. Seneviratne will customize the approach to the individual tear. Most tears are treated with the double row technique for its stronger biomechanical fixation. He has studied this question directly, including basic-science research comparing double row and single row repair.
Recovery
Rotator cuff repair is an ambulatory procedure — patients go home the same day. Pain is usually manageable with Tylenol after the first few days on narcotic medication; NSAIDs are avoided for six weeks after surgery, since they can impede tendon healing. A sling is worn for roughly three to six weeks, and physical therapy starts around four to six weeks after surgery. Early healing is underway by six weeks; full healing takes four to six months. Most patients are largely pain-free by six weeks and functional by three months, though recovery is individual and paced by Dr. Seneviratne.
Common questions
What is the re-tear rate after surgery?
In Dr. Seneviratne's experience the re-tear rate after arthroscopic rotator cuff repair is roughly 10%. Published literature shows higher rates. Many factors affect the risk, and Dr. Seneviratne factors in patient activity level, sport participation and imaging findings when choosing the right operation for the right patient.
Can I get arthritis after a rotator cuff tear?
Yes — particularly if there is fatty infiltration of the muscle.
What are the risks of arthroscopic rotator cuff repair?
Infection, bleeding, damage to nerves or blood vessels, re-tear of the repair, and shoulder stiffness.
Will I have hardware in my shoulder?
The tendon is repaired using tiny suture anchors drilled into the greater tuberosity of the humerus. These are typically suture material, and patients do not feel them.
How soon after surgery can I drive?
Usually 6 weeks, though as early as 3 weeks if it is the non-dominant arm.
How soon can I return to work?
About 1–2 days depending on the occupation, though a week off is generally recommended.
How soon can I shower?
In 48 hours.
How soon can I fly?
About 1 week — arrange for an aisle seat, have bags handled by someone else, and do ankle pumps every 15 minutes in flight, since DVT is a real concern on a long recovery flight; low-dose aspirin is also advised unless your own physician says otherwise.
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