The name of the tendon in the shoulder is the “rotator cuff tendon.” Rotator cuff tendon injuries most commonly occur due to the wear and tear associated with aging. Often, what appears as a minor injury causes the tendon to give way. On occasion, a single injury will cause the problem.
Dr. Gartsman will recommend rotator cuff repair if you experience pain when using your arm in positions over your head, weakness in the arm and a bone spur or inflammation around the rotator cuff. There are other options available, including no treatment, physical therapy exercises or pain medication, which Dr. Gartsman does not find to be reliable.
In the majority of cases, tendon repair is possible. About five percent of the time, this is not possible. In this situation, the removal of inflammation, scar tissue and bone spurs helps to diminish the pain but overhead use usually does not return to normal.
Rarely will the condition improve without surgery when the tendon tears. Most often, the pain increases and the movement and strength decrease. Fortunately, this usually occurs slowly over the years.
The Surgery Experience
Surgery is performed to suture the torn tendon ends to the bone. During surgery, Dr. Gartsman also will remove any inflamed bursa or bone spurs that would delay tendon healing.
General anesthesia is used during the surgery. At the end of the operationi Dr. Gartsman will give you an injection of a type of novocaine around the nerve that goes to the shoulder. This lasts 4-24 hours and will help decrease your pain after the surgery.
Following surgery you will awaken in the recovery room with your arm in a sling. An ice pack called a Cyro Cuff is used to control the pain and swelling. You will remain in the recovery room for two to three hours and will stay overnight in the hospital to ensure no medical problems develop. Most patients go home the next morning.
During shoulder arthroscopy, a small camera, called an arthroscope, is inserted near the shoulder joint through a small (usually one-quarter inch) incision. The arthroscope is attached to a video monitor to allow Dr. Gartsman to look inside your joint.
Instead of making a large incision, Dr. Gartsman uses three small (about 1/2") incisions. Through one incision, he inserts the arthroscope to look inside your shoulder. He inserts special instruments that allow the removal of scar tissue and bone through the other two incisions. Dr. Gartsman will then insert small metal screws into the shoulder.
There are sutures attached to the eyelets of the screws. We use special instruments to weave the sutures through the torn tendon. The screws are inside the bone and you cannot feel them. They do not have to be removed. The screws will not set off airport sensors.
|The rotator cuff muscles and their tendons.
||A typical location for a rotator cuff tendon tear.
|The suture anchors are inside the bone.The
green and white sutures are ready for the repair.
||The sutures have been placed through the torn tendon.The sutures hold the tendon in
position while it heals to the bone.
Download Rotator Cuff Repair Diagrams
How Successful is the Surgery?
Surgery to repair a torn rotator cuff is almost always successful in alleviating shoulder pain. Returning strength to the shoulder is more difficult to guarantee. This type of surgery is successful about 85-95% of the time. No shoulder operation is 100% successful in every individual but the procedures we perform are reliable and will help restore the potential function in your shoulder. Because of the many variables involved, I can make no guarantees other than to assure you I will deliver the very best medical care possible.
Your first office visit is three weeks after surgery so that Dr. Gartsman can examine the surgical incision. He will give you additional instructions for exercises and discuss your allowed activity level. Six weeks after surgery, more vigorous use of the shoulder will be allowed. Office visits then occur three, six and 12 months after your surgery.
Returning to Work
For most sedentary jobs, Dr. Gartsman recommends taking a week off from work. When you return to work your arm will be in a sling (for 6 weeks after surgery), but you should be able to manage as long as you do no lifting, pushing, pulling
You are not to raise your arm without help for six weeks after surgery. This allows the tendon to heal in the best possible position. You may begin light duty work involving no lifting, pushing, pulling or carrying, within two weeks after surgery; you may work at waist level and lift 5-10 pounds 3-4 months after surgery. Most patients can tolerate occasional work at shoulder level 3-6 months
after surgery, but a return to heavy lifting or overhead use may require 6-12 months.
You will do a simple exercise for 2 minutes, 5 times a day. 10 Minutes of daily rehabilitation that you can do yourself at home is all that is needed.
You will be examined three weeks after surgery to determine if you need physical therapy (only about 10% of patients require regular visits to a physical therapist).
You will still use the sling and cannot raise your arm up or away from your side. I will see you next six weeks after surgery and you should be able to remove the sling. Doctor visits will continue for six weeks after surgery, as well as visits to the therapist for additional exercises. At the three-month visit, you will begin strengthening exercises.
The most common complication from rotator cuff repair involves the loosening of the bone screws (suture anchors), which occurs in less than 1% of patients. Dr. Gartsman uses these small metal implants to reattach the torn tendons. There is always a possibility they would have to be removed surgically if they loosen or cause irritation.
Infection can require antibiotic treatment with pills or by injection. Rarely, surgery
is necessary. Other possible complications include:
- Wound problems including swelling, bleeding, delayed healing, unsightly or
- Bone infection or fracture.
- Joint problems including stiffness or arthritis could occur.
- Failure to achieve the desired result is not strictly a complication but it can be a source of disappointment.
- This operation may result in incomplete motion, strength or function.
- Nerve injury is extremely rare but may result in temporary or permanent, partial or complete loss of feeling and/or movement in the arm.
Standard Rotator Cuff Tear
Rotator Cuff Tear with Partial Thickness Cuff Tear
Arthroscopic Rotator Cuff Repair Animation Clips
Large Rotator Cuff Tear
Rotator Cuff Tear with Margin Convergence
Download Arthroscopic Rotator Cuff Repair Preoperative Instructions.
Download Arthroscopic Rotator Cuff Repair Postoperative Instructions.