Irreparable rotator cuff tear
In the shoulder, the rotator cuff tendons have to pass between a small space between two bones, the acromion and the humerus. Normally, the tendons just pass through the space as the arm is raised and rotated. With repeated overuse, a single injury or even just the wear and tear of age, the tendon increases in size so that it becomes pinched or impinged when it passes between the two bones. |
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In some individuals, the process occurs very slowly and over time the damage can be so severe that the tendons can't be repaired. Resulting shoulder pain is a result of bursitis , inflammation , bone spurs and scar tissue.
The indications for surgery are persistent pain interfering with your activities of daily living, work and/or sports. If surgery is not performed, the problem will most likely continue. With time, the pain may become more severe. Other options are available, including no treatment, physical therapy exercises, medication and/or injections, although they are not reliable.
The Surgery Experience
During surgery, Dr. Gartsman inspects the shoulder joint as well as the ligaments and tendons.
General anesthesia is used during this type of outpatient surgery. Novacaine that lasts 12-18 hours is injected around the nerve that goes to the shoulder, which will help decrease the pain after surgery.
This surgery is done using arthroscopic technique. Instead of a large incision, Dr. Gartsman uses two to three small (about 1/2") incisions. Through one incision, he inserts the arthroscope which allows him to look inside your shoulder. Dr. Gartsman uses small, motorized instruments to remove any inflamed or scarred tissue contributing to the problem. He then uses a special instrument to remove any portion of the bone that is causing pressure on the tendons. (Bone and scar tissue removal increases the space through which the tendons pass, and allows recovery in 80% of patients.)
Following surgery, you will awaken in the recovery room with your arm will be in an attached ice pack to control the pain and swelling.
Surgery Results
This type of surgery is successful about 80% 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.
Doctor’s Visits
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 and six months after your surgery, if necessary.
Returning to Work
For most sedentary jobs, Dr. Gartsman recommends two to three days off from work. When you return to work, your arm will be sore but you should be able to manage as long as you do no heavy lifting, pushing, pulling or carrying. Work at waist level and 5-10 pounds or lifting can begin one week after surgery, but heavier lifting and work at or above shoulder level should wait until three months after surgery. You will generally need 6-12 months before recovery is complete.
Rehabilitation
You may enjoy walking, and stationary bicycle riding within one week after
your surgery. Jogging, Stairmaster and regular bicycle riding can start as soon as you feel comfortable, as can gentle golf strokes. Swimming and tennis ground strokes start one to two months after surgery, while a return to overhead throwing and tennis strokes can require six to 12 months
of rehabilitation.
Complications
The most common complication from rotator cuff tears involves injury to nerves around the shoulder. These usually go away in two days to six weeks (this occurs in less than 1% of patients). Permanent injury that results in diminished use, function or feeling in the extremity can occur but is exceedingly rare. Infection can occur (1-2% chance), and may require antibiotics by pills or by injection. Rarely, surgery is necessary.
Irreparable Rotator Cuff Tear with Biceps Tenotomy
Related Files
 Click here to download Surgical Treatment of Irreparable Rotator Cuff Tears from Dr. Gartsman.
Click here for Irreparable Rotator Cuff Tear Postoperative Instructions.
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