What is the Rotator Cuff?
The rotator cuff is a group of four muscles that work together to help move the shoulder and keep it stable. The muscles are deep to the larger deltoid and pectoralis muscles and are not usually visible under the skin. They originate on the shoulder blade and insert on the humerus head (ball portion of the ball and socket shoulder joint).
What are the major risks of the procedure?
The most common risk is stiffness. For this reason we will have you enrolled in a physical therapy program after the surgery. When you start your therapy the extent of your exercises will be determined by a number of factors including what approach was used for surgery (open vs arthroscopic), quality of your cuff tissue and size of the tear.
Will you do the procedure through small incisions (arthroscopy)?
Often rotator cuff repair can be performed completely through a series of small incisions that are about a centimeter in length. I perform the majority of my rotator cuff repairs this way.
What are the advantages of arthroscopy?
There are a few main advantages of arthroscopy:
- Less pain. One of patient’s biggest concerns after surgery is their pain level. Rotator cuff repair via arthroscopy may be less painful in the early period after surgery than larger incision approaches.
- The deltoid is a large shoulder muscle that originates from the top of the shoulder blade. Open approaches to the shoulder typically involve some detachment of this muscle from the origin. At the end of the case it is important for the surgeon to repair the deltoid securely to bone. While rare, failure of this repair can be very problematic. When you use arthroscopy you do not have to detach this muscle and there is virtually no risk of the deltoid detaching after surgery. This is a big advantage.
- Cosmetics. While even “open” scars can be cosmetic in appearance, arthroscopy incisions tend to be fairly discrete.
When would you “open” the shoulder to do a rotator cuff repair?
In my practice I do most rotator cuff repairs completely with arthroscopy. In rare cases I do “open” rotator cuff repairs with a slightly larger incision. This is usually related to the size and retraction of a tear. Some tears are so large and require very sophisticated scar release that patients may be better served with an open repair.
If your tear requires a graft augmentation, I will often perform that procedure “open” as well.
How long is the recovery period for a full thickness rotator cuff repair?
I counsel patients that maximal improvement often takes up to a year. However most of your recovery will be achieved in the first 6 months.
In general the recovery breaks down into a few general phases.
Phase 1 is the early postoperative period and usually lasts about 6 weeks. You will wear a sling for the majority of this phase and will see the surgeon about 2 weeks after surgery and at about 6 weeks. Your therapy will focus on active elbow, wrist and hand motion and possibly passive shoulder motion.
Phase 2 encompasses week 7-12 and you can usually discontinue wearing your sling. You can often go back to driving and your therapy should focus on achieving full active motion of the shoulder with excellent mechanics.
After 3 months you will commence strengthening and continue this phase until you reach full strength. You will gradually transition to doing exercises independently.