• Rotator Cuff Repair

    Definition

    The rotator cuff is a group of four muscles in the shoulder and upper arm. The muscles help to move the arm at the shoulder and also help to stabilize the joint. The muscles are connected to the shoulder bone by tendons, which are strong, flexible cords. Tendons may become damaged from long term overuse or from injury.
    A rotator cuff repair is a surgery to repair damage to the rotator cuff.
    Rotator Cuff Tear
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    Reasons for Procedure

    Your doctor may recommend this surgery for:
    • A rotator cuff injury which does not respond to rest and physical therapy treatment
    • A complete tear in the tendon
    • Chronic pain and weakness from a partial tear in the tendon

    Possible Complications

    Complications are rare, but no procedure is completely free of risk. If you are planning to have this repair, your doctor will review a list of possible complications, which may include:
    • Infection
    • Bleeding
    • Scarring within the shoulder joint
    • The operation does not provide the desired improvement in function
    • Reaction to anesthesia
    Factors that may increase the risk of complications include:

    What to Expect

    Prior to Procedure

    Your doctor may do the following:
    • Physical exam
    • Blood tests
    • An x-ray of the shoulder
    • An MRI of the shoulder—a test that uses magnetic waves to make pictures of structures inside the body
    Leading up to the procedure:
      Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
      • Aspirin or other anti-inflammatory drugs
      • Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)
    • Do not eat or drink anything for at least 8 hours before surgery.
    • Arrange for a ride to and from the procedure.

    Anesthesia

    General anesthesia is typically used. You will be asleep.

    Description of Procedure

    There are two methods used to perform a rotator cuff repair:
    Open Surgery
    The doctor will make a large cut in the skin over the shoulder. The torn tendon will be repaired and reattached and/or anchored with stitches. The incision will then be closed with stitches or staples.
    Arthroscopic Surgery
    A few small incisions will be made in the shoulder. A narrow tool called an arthroscope will be inserted through the incision. The scope has a tiny camera to allow the doctor to see inside. Other small instruments will be inserted through the other incisions. The doctor will use these tools to repair the tendon.
    After either procedure, the incisions will be bandaged. Your arm will be placed in a sling. The sling will prevent movement while you heal.

    How Long Will It Take?

    About 1-½ to 2 hours

    How Much Will It Hurt?

    Anesthesia prevents pain during the procedure. You may have some discomfort immediately after. Your doctor can give you medicine to help manage this.

    Average Hospital Stay

    You may be able to go home the same day. Some may need to stay in the hospital for one day.

    Post-procedure Care

    When you return home, do the following to help ensure a smooth recovery:
    • Use ice to reduce swelling during the first 24-48 hours after surgery.
    • Take the full doses of all medicines prescribed.
    • Keep the bandage clean and dry at all times.
    • Ask your doctor about when it is safe to shower, bathe, or soak in water.
    • Do not use the arm until instructed. Wear the sling as directed.
    • Unless your job requires heavy lifting, you can usually return to work within a few days after surgery.
    • Follow instructions for physical therapy. Therapy is essential to regain shoulder strength and range of motion.
    • Be sure to follow your doctor's instructions .
    The rotator cuff will take several months to heal. It may take some time before you can raise your arm above your shoulder. It may be up to one year before you can hold your arm above your head and do work with reasonable strength. An aggressive and consistent exercise program is the key to a faster recovery.

    Call Your Doctor

    After arriving home, contact your doctor if any of the following occurs:
    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, excessive bleeding, or discharge at the incision site
    • Cough, shortness of breath, chest pain, or severe nausea or vomiting
    • The stitches or staples come apart
    In case of an emergency, call for medical help right away.

    RESOURCES

    American Academy of Orthopaedic Surgeons http://www.aaos.org/

    The American Orthopaedic Society for Sports Medicine http://www.aossm.org/

    CANADIAN RESOURCES

    Canadian Orthopaedic Association http://www.coa-aco.org/

    Health Canada http://www.hc-sc.gc.ca/index-eng.php

    References

    University of Iowa Health Care website. Available at: http://www.uihealthcare.com/ .

    6/2/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

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