The rotator cuff is a group of four muscles that run from the scapula (shoulder blade) and attach to the humeral head (top of the upper arm bone) by their tendons. Rotator cuff surgery may be indicated for people who have a symptomatic rotator cuff tear that causes pain and/or weakness and affects daily activities.
The goal of surgery is to eliminate shoulder pain and attempt to regain active motion and strength by reattaching the torn rotator cuff tendon to the upper arm bone using sutures connected to anchors placed in the bone.
What Is Arthroscopic Rotator Cuff Repair?
When the rotator cuff is torn, the tendon usually tears away from the humerus (upper arm bone), retracts, and cannot heal back on its own. Over time, rotator cuff tears tend to progress and become larger and more symptomatic. The tendon may retract further, while the rotator cuff muscle can atrophy (shrink and weaken) and degenerate. This can make repair technically more difficult and potentially not possible.
Dr. Chudik approaches rotator cuff tears arthroscopically through small incisions called arthroscopic portals and can repair even severe rotator cuff tears entirely arthroscopically.
During repair, anchors are placed in the bone and sutures are used to grasp the tendon and hold it in place. The sutures and anchors hold the tendon until it gradually grows back to the bone over four to six months.
Who Is a Candidate?
Rotator cuff surgery may be indicated for people who have a symptomatic rotator cuff tear that causes pain and/or weakness and affects daily activities.
Surgery may not be appropriate in the presence of:
- Infection
- Shoulder stiffness
- Poor general health that is not sufficient to proceed with surgery
- An inability or unwillingness to complete the postoperative program, including wearing a sling for six to eight weeks and participating in physical therapy for four to six months
The reparability of a rotator cuff tendon cannot always be completely predicted before surgery. MRI has limitations, and in some cases an irreparable tear may be found during surgery. Fortunately, most tears are technically reparable.
How the Procedure Is Performed
Arthroscopic rotator cuff repair is performed as outpatient surgery, allowing patients to go home the same day. General anesthesia with an interscalene nerve block is used.
Dr. Chudik uses small incisions to look inside the shoulder joint with a camera. Special instruments are then used to repair the rotator cuff and address other problems seen in the joint.
The torn rotator cuff tendon is repaired back to the bone of the humerus using anchors placed in the bone and sutures that grasp the tendon. These anchors and sutures hold the tendon in place while it gradually grows back to the bone over four to six months.
Other damage, including problems involving the biceps tendon, labrum, or articular cartilage, may be identified during surgery and may require further treatment at that time.
Recovery and Rehabilitation
Following surgery:
- A sling is worn at all times except for bathing, dressing, and exercises for six to eight weeks, including while sleeping.
- The repaired shoulder should not be actively moved using its own shoulder muscles for at least six to eight weeks to protect the repair and allow healing. Elbow movement may also be restricted if the biceps tendon is involved.
- Driving is restricted for six to eight weeks.
- Patients may return to school or sedentary work in less than one to two weeks as long as the arm remains in the sling and the extremity is not used.
- Physical therapy should begin two to three days after surgery and continue for four to six months.
The success of rotator cuff repair is highly dependent on postoperative rehabilitation, making it important to follow and maintain the prescribed therapy schedule.
Patients may return to unlimited activities when there is no pain and full shoulder range of motion, muscle strength and endurance, and functional use have been restored. This usually requires four to six months following rotator cuff repair. Dr. Chudik will determine when it is safe to resume all activities and has specific protocols for returning to sports such as throwing and golf.
Risks and Outcomes
Potential surgical risks and complications include:
- Infection
- Injury to nerves of the shoulder or arm, which may cause numbness, weakness, or paralysis
- Continued or recurrent pain
- Re-tear of the rotator cuff tendon
- Stiffness or loss of shoulder motion
- Persistent shoulder weakness
- Inability to return to the same level of athletics or work
- Late acromioclavicular (AC) joint pain
- Arthritis
- Finding an irreparable tear during surgery
- Finding damage to other structures, such as the biceps tendon, labrum, or articular cartilage, that may require additional treatment during surgery
- Detachment of the deltoid muscle if open surgery is performed
Why Dr. Chudik for Rotator Cuff Repair
Dr. Chudik has performed arthroscopic rotator cuff repair for more than two decades and treats the full range of cuff pathology, from small partial tears to massive multi-tendon ruptures. Dr. Chudik approaches rotator cuff tears arthroscopically through small incisions and can repair even severe rotator cuff tears entirely arthroscopically.
He uses a camera and specialized instruments to examine the shoulder joint, repair the rotator cuff, and address other problems identified in the joint.