Rotator cuff surgery

Overview of rotator cuff surgery

The rotator cuff tendon controls the motion of your shoulder joint. If this tendon tears or is damaged, it may require a surgery called rotator cuff repair. A rotator cuff surgery repairs the tendon, allowing you to heal from an injury, move, and use your shoulder without pain.  

When it comes to diagnosing, repairing, and treating torn tendons and rotator cuffs, there is no better source for reliable information and care than the Dignity Health network. Our orthopedic specialists are well-versed in many rotator cuff procedures and treatments to help you get back to the activities you love. 

Why it’s necessary

A torn rotator cuff weakens your shoulder to the point that it may make daily activities such as getting dressed painful or difficult. Rotator cuff injuries are common, but not all of them need to be treated with surgery. Rotator cuff surgery is generally considered necessary if: 

  • The tear is from a recent injury. 
  • The tear is more than 3 centimeters long, and the surrounding tendon tissue is of good quality. 
  • The tear has been causing pain for more than six months. 
  • You can’t use your shoulder regularly. 
  • Nonsurgical treatments, like physical therapy, nonsteroidal anti-inflammatory medications, or oral or injected corticosteroids, have not worked. 

To determine whether you are a good candidate for surgery, your doctor will take a medical history, discuss your shoulder symptoms with you, and examine your shoulder. Your doctor will look for deformities and tender areas, assess your range of motion and strength, and also look into other potential problems with your shoulder joint. 

Before surgery, your doctor will also use diagnostic tests such as x-rays or MRI scans to help confirm your diagnosis. X-rays are not the most helpful for soft tissue injuries such as rotator cuff tears but will show a bone spur if any are present. MRI scans better show soft tissue and can often give your doctor an idea of how long your shoulder has been torn.  

Types

The type of repair surgery you need will largely depend on the size of your tear, your anatomy, and the quality of the tendon tissue and bone. Rotator cuff surgery types include open, mini-open, and minimally invasive arthroscopic procedures.  

  • Open repair is when a traditional surgical incision that is several centimeters long is made over the shoulder. The deltoid shoulder muscle is detached to gain better access to the torn tendon. Open repairs are a good option if the tear is large or complex, or if additional reconstruction is necessary.  
  • Arthroscopic repair is done with miniature instruments, a small camera (called an arthroscope), and a television screen. It requires only tiny incisions because the instruments are very thin. Arthroscopic surgery is minimally invasive and is usually an outpatient procedure. 
  • Mini-open surgery combines minimally invasive arthroscopic techniques with a smaller open procedure. These approaches result in smaller incisions, less pain, and a shorter recovery period than open surgery. Mini-open repairs use arthroscopy to assess and repair the damage to the joint. It avoids needing to detach the deltoid muscle. Still, your surgeon will go in after the arthroscopic portion of the surgery is complete to repair the rotator cuff through a 3 to 5-centimeter incision. Your surgeon will view your tendons directly instead of on a video monitor 

Risks

As with any surgery, there are risks to rotator cuff surgery. Though complications are rare, there are risks associated with any general surgery and risks specific to rotator cuff procedures. They include: 

  • Blood loss
  • Infection at the surgical site
  • Allergic reaction to medicines or the drugs used for anesthesia
  • Nerve injury, usually related to your deltoid muscle. 
  • Deltoid detachment. If you have an open repair, your deltoid is moved for the procedure. In rare cases, the muscle can detach if it is not protected after the surgery to heal fully. 
  • Stiffness in the shoulder joint, though this side effect can often be avoided with early rehabilitation. 
  • Surgical failure or tendon reinjury. If you had an extensive initial tear, there is some likelihood that the repair won’t “hold,” or that you will reinjure your shoulder later on. In this case, repeat surgery may be needed if you have significant pain or lack of functionality associated with a new injury. 

The information contained in this article is meant for educational purposes only and should not replace advice from your healthcare provider.