What is rotator cuff surgery?

Surgery may be used to treat a torn rotator cuff if the injury is very severe or if nonsurgical treatment has not improved shoulder strength and movement sufficiently.

Surgery to repair a torn rotator cuff tendon usually involves:

• Removing loose fragments of tendon, bursa, and other debris from the space in the shoulder where the rotator cuff moves. (This is called debridement.)
• Making more room for the rotator cuff tendon so it is not pinched or irritated. If needed, this includes shaving bone or removing bone spurs from the point of the shoulder blade. (This is called subacromial smoothing).
• Sewing the torn edges of the supraspinatus tendon together and to the top of the upper arm bone (humerus).

Arthroscopic surgery is the most common way that this surgery is done. But in some cases, the surgeon needs to do open-shoulder surgery, which requires a larger incision.

Surgery to repair a rotator cuff may be done when:

• A rotator cuff tear is caused by a sudden injury. In these cases, it's best to do surgery soon after the injury.
• A complete rotator cuff tear causes severe shoulder weakness.
• It is likely that the rotator cuff tear could worsen.
• You do not have other shoulder problems, such as arthritis.
• The rotator cuff has not improved with several months of conservative nonsurgical treatment alone (such as physical therapy).
• You need full shoulder strength and function for your job or activities, or you are young.
• You are in good enough physical condition to recover from surgery and will commit to completing a program of physical rehab.

Rotator cuff repair surgery for a tear from a sudden injury works best if it is done within a few weeks of the injury. But repairs of very large tears aren't always successful.

Rotator cuff surgery to repair frayed or thinned tendon tissue is less likely to work than surgery to repair an injury to a healthy tendon.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• You may need to shower or bathe with a special soap the night before and the morning of your surgery. The soap contains chlorhexidine. It reduces the amount of bacteria on your skin that could cause an infection after surgery.
• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover. Do not lie flat or sleep on your side. Raise your upper body on two or three pillows, or sleep in a reclining chair.
• Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation.
• Your arm will be in a sling or other device to prevent it from moving for several weeks.
  • Always use the sling when you walk or stand.
  • If you sit or lie down, you can loosen the sling, but don't remove it. This lets your elbow straighten without moving the shoulder. You can also support your arm on a pillow.
  • Remove the sling only to do prescribed exercises or to shower.
• You will not have complete use of your affected arm for a few months after surgery.
  • You can use your affected arm for writing, eating, or drinking, but move it only at the elbow or wrist. Do not use it for anything else except prescribed exercises until the sling has been removed.
  • When the sling has been removed, you can do activities that don't involve lifting, pushing, pulling, or carrying. You may not be able to do overhead lifting for several months.
• If you have a desk job, you may be able to go back to work or your normal routine in 1 to 2 weeks. If you have a more active job, you may be away from work for a few months. If you work at a job that involves heavy manual labor, lifting your arms above your head, or the use of heavy tools, you may have to think about making changes to your job.
• If you had arthroscopic surgery, you can take a shower 48 to 72 hours after surgery. Remove the sling, and leave your arm by your side. To wash under your armpit, lean over and let the arm fall away from your body. Do not raise your arm. You may want to use a shower stool for a day or two.
• If you had open surgery, do not shower until you see your doctor and your doctor okays it. You can wash the incisions with regular soap and water.
• Ask your doctor when you can drive again. This may take several weeks or until you are no longer wearing the sling.

Diet

• You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt. Drink plenty of fluids.
• You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Medicines

• Your doctor will tell you if and when you can restart your medicines. You will also be given instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed. Use pain medicine when you first notice pain, before it becomes severe. It's easier to prevent pain early than to stop it after it gets bad.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.

Incision care

• If you had arthroscopic surgery, you may remove the bandage over your cut (incision) 24 to 48 hours after the surgery. Keep the bandage clean and dry.
• If you had open surgery, do not remove your bandage until you see your doctor and your doctor okays it. Keep the bandage clean and dry.
• If your incision is open to the air, keep the area clean and dry.
• If you have strips of tape on the incision, leave the tape on for a week or until it falls off.

Exercise

• Shoulder rehabilitation is a series of exercises you do after your surgery. This helps you get back your shoulder's range of motion and strength. You will work with your doctor and physical therapist to plan this exercise program. Shoulder rehab may not start until a few weeks after the surgery. To get the best results, you need to do the exercises correctly and as often and for as long as your doctor tells you.

Ice

• To reduce swelling and pain, put ice or a cold pack on your shoulder for 10 to 20 minutes at a time. Do this every 1 to 2 hours. Put a thin cloth between the ice and your skin. If your doctor recommended cold therapy using a portable machine, follow the instructions that came with the machine.