Recovery Period For Rotator Cuff Tear Surgery – We strive to provide the best and most up-to-date information for those concerned with arthritis of the shoulder and rotator cuff pathologies.
If you have questions about the ream and run process feel free to email Frederick A. Matsen III M.D. at [email protected].
Recovery Period For Rotator Cuff Tear Surgery
Not all surgical cases are the same, this is just an example used in patient education.
Rotator Cuff Surgery Recovery Timeline
The rotator cuff is the most common tear in the shoulder. Rotator cuff tears often produce symptoms of weakness and pain especially when trying to raise the arm. If a severe injury causes a rotator cuff tear consideration should be given to surgical repair within 6 weeks of the injury to prevent atrophy of the muscle and tendon. Long-term rotator cuff tears and those that come uninjured can benefit from a course of rehabilitation exercises (see ‘home exercises for a stiff shoulder’ and ‘home exercises for a weak shoulder’ on our website www.). If these exercises do not help, consideration can be given to surgery of the rotator cuff – either to smooth out the damage from the tear or if the tissue is of good quality and more to do surgical repair.
The rotator cuff attaches almost all the way around the ball of the shoulder (humeral head). The biceps tendon runs across the top of the shoulder dividing the rotator cuff into an anterior half and a posterior half.
In a rotator cuff tear the edge of the rotator cuff tendons are pulled from their normal attachment to the humeral head. This can occur from a sudden force on the shoulder such as a fall on the arm or from progressive wear.
In acute rotator cuff tears there is a history of injury followed by weakness of the shoulder. In chronic cuff tears the history is usually one of weakness that progresses over time. An examination of the shoulder may show stiffness during shoulder movement and weakness on testing of the specific rotator cuff muscles such as those that raise the arm.
Rotator Cuff Tears: You Can Get Back To Normal Even With A Full Rotator Cuff Tear
Using shoulder ultrasound or MIR gap in the rotator cuff tears can be seen (arrows) and the quality of the remaining rotator cuff tendons can be assessed.
In patients who are healthy and do not smoke, repair of the rotator cuff can be achieved as long as there is a sufficient amount of good health for the repair. Over time after the tear the muscle weakens and is redistributed leaving the humeral head exposed and making cuff fixation less likely.
The rotator cuff tendon is collected from any scar tissue around it and brought to its normal attachment to the humerus at the edge of the humeral head. A groove is made at this point and sutures are placed in order to bring the edge of the tendon into the groove.
In this surgical image one can see how the cuff has been safely brought to the golf course in the humerus leaving the upper surface of the repair.
Managing The Failed Rotator Cuff Repair
If good quality tissue is not available the repair cannot deal with use and time. In these situations it is often helpful to do a ‘soft and go’ operation. In this procedure all the scar tissue and rough edges of the tendon and bone are removed from the shoulder and gentle manipulation is done so that the full range of motion is achieved. After this operation, the shoulder can be moved immediately since there is no need for protection. Patients can return to work quickly; exercises aimed at maintaining range of motion and building strength in muscles and tendons remain strong.
Surgery should be considered especially in cases where sudden weakness follows a shoulder injury and when examination and ultrasound or MRI show a rotator cuff tear with reasonable residual tissue for repair. In the shoulders with a gradual onset of weakness of the shoulder and without a major injury surgery can be considered if stretching and strengthening the exercise program does not provide the desired improvement. Preoperative ultrasound or MRI along with a thorough examination can indicate whether repair may be possible or if smoothing and movement may be the method of choice.
A cuff repair is less likely to be successful in people with arthritis, shoulder stiffness, obesity, diabetes, Parkinson’s disease, more frequent shoulder surgeries, and more flexible shoulder anatomy. Patients who use narcotic drugs or smoke cigarettes are usually not the ones who want to do this.
Success requires a healthy patient with good surgical skills and a strong commitment by the patient to the rehabilitation program prescribed by the surgeon.
Rotator Cuff Surgery Recovery Time
For all elective surgical procedures the patient must be in excellent physical and mental health at the time of the procedure. Any heart, lung, kidney, tooth or gum problems should be taken care of before surgery. Any infection can be the reason for the delay in operation. Any skin problems (acne scratches rashes blisters burns etc) on the shoulder or arm must be fixed before surgery. A shoulder doctor should be aware of all health issues including allergies as well as over-the-counter and prescription medications. For example aspirin and anti-inflammatory drugs can affect blood clots. Some of these may need to be fixed or stopped during surgery.
Rotator cuff surgery is a surgical procedure that can cause pain immediately after the operation – this is the case of the repair of the main cuff tear with a smooth and moving process. Pain from this surgery is managed with anesthetic and pain medication. Immediately after surgery strong drugs (such as morphine or Demerol) are usually given by injection. Daytime or oral pain medications (such as hydrocodone or Tylenol with codeine) are usually sufficient. The patient is encouraged to get up and out of bed shortly after surgery and gradually reduce their use of pain medication. Discharge from the hospital usually occurs on the second or third day after surgery. After rotator cuff repair patients should not raise their arm strongly (that is without help) for weeks or months following the procedure as described by the surgeon. During this healing time the arm is protected in a sling. Patients should avoid lifting one pound while pushing and pulling for six weeks after surgery. Driving is not recommended for the first six weeks after surgery. Therefore the patient needs to be prepared to have less hands to work for the first month or after the operation than immediately before the operation. For this reason patients often need help with self-care activities such as shopping and driving for about six weeks after surgery. Management of these limitations requires progress in organizing activities of daily living during recovery. After the repair and walking around the use of the shoulder starts immediately after the operation in that there is no concern about the repair.
Patients are usually able to perform gentle ‘hand to mouth’ activities using the operated arm from two to six weeks after cuff repair. The rate of progression from that point is determined by the surgeon in light of the condition of the lung found during surgery.
Once the shoulder has full range of motion and comfort the patient can gradually resume activities. It is important to remember however that even with a strong and complete repair and good healing the tendon will continue to suffer from re-injury up to a year after surgery.
Can A Rotator Cuff Tear Heal On Its Own?
Like all surgeries, rotator cuff surgery can be complicated by nerve or blood vessel injury, fracture discomfort and anesthetic complications. Furthermore this is a technical procedure and requires an experienced surgeon to optimize the bony prosthetic and soft tissue anatomy during the procedure. The most common causes of failure are (1) failure of the rotator cuff to heal or (2) scar tissue that limits movement after the procedure.
If the shoulder remains stiff and painful despite the patient’s efforts attention may be given to surgery to release the scars if it is possible to repair the recurrence if the health is perfect and the amount of tissue remains. If this is not the case a smooth road and movement can help restore comfort and functionality.
We currently perform approximately 60 of these procedures each year on carefully selected patients from across the United States.
Because these procedures are not performed in many places across the United States patients often come to Seattle from long distances for the procedure. We are available by appointment in the Shoulder and Elbow Clinic 4245 Roosevelt Way N.E. Seattle on Monday and Friday to examine people with shoulder arthritis to discuss what procedures might be best for them. We perform surgery on Tuesdays and Wednesdays at the University of Washington Medical Center 1959 NE Pacific St Seattle Washington. Patients who have rotator cuff surgery are usually able to recover
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