MRI: Moderate wear, rotator cuff tendon

MRI: Torn rotator cuff

Why this surgery might help:

  • Most of my patients’ shoulder pain has come on over time, from impingement: friction between the rotator cuff tendon and the edge of the shoulder blade (acromion).
  • This rubbing can eventually wear a hole in the tendon, or the tendon can tear from a sudden injury.
  • An MRI will show how worn, torn or retracted the tendon is.
  • XRays and the MRI will also show any arthritis or loose bone/cartilage fragments in the ball-and-socket joint.
  • It might be time for surgery if:
    • Acute rotator cuff tear after an injury.
    • Pain and/or weakness in your shoulder interfere with quality of life despite conservative treatment: time, rehab exercises, medication, cortisone shot…
    • A sharp bone spur or calcium deposit rubs on the tendon
    • Your rotator cuff is torn and you want to preserve strength in your shoulder (the tear cannot heal on its own.)
    • A cortisone shot relieved your symptoms, but didn’t last more than 3, 6 or 12 months (depending on your age).
    • Your other health issues are stable and won’t interfere with safe surgery or recovery.
  • Even after you’ve healed and feel better, keep exercising regularly for maintenance.

What is done?

It depends on your problem:

“Arthroscopic” Surgery: Acromioplasty, Debridement

  • Two or three ½” incisions. A pencil-thin camera and tools smooth the bone spur (acromion) and bursitis causing your pain.
  • The scope tools can also clear torn cartilage and remove loose fragments from the ball-and-socket joint.
  • The arthritic end of your collarbone is removed through a separate, 1-2” incision.
  • Photos are taken during the procedure; you’ll see them at your postop appointment.

“Open” Surgery: Rotator Cuff Repair, Acromioplasty

  • Done through a 3-6” incision on top of your shoulder (depending on your body size).
  • Torn rotator cuff tendon is reattached to the bone with heavy stitches. (Dr. Siegrist does not repair rotator cuff tears arthroscopically.)
  • Sometimes, the tendon tissue cannot be completely repaired because it is flimsy, retracted and scarred-in. But, repairing what’s possible and smoothing the frayed tissues relieves pain.
  • The bone spur is smoothed (Acromioplasty), and the arthritic end of your collarbone is removed.
  • “Open” surgery takes about half as much time as a “scope” and is safer if you’re on blood-thinners, or have significant medical issues, or if your shoulder is too large for the ‘scope instruments.

Outpatient surgery (you go home the same day):

  • Takes about 2 hours. You will be completely asleep (general anesthesia.)
  • The anesthesiologist or surgery center nurse will call you the night before surgery to review details.
  • You will need someone to drive you home. Expect to be at the surgery center for at least 4-5 hours.

How long will healing take?

It depends on whether the rotator cuff had to be repaired

  • Expect about 75% function by 4-6 weeks postop with a scope or 8-10 weeks after rotator cuff repair.
  • Full recovery depends on the condition of your shoulder, how much tissue has to heal, your general fitness and your commitment to the rehab exercises; it could take up to 1 year for full healing.
  • You’ll wear a sling for the first few weeks to support your shoulder while it heals. You can use your hand for light activities near the body like holding a toothbrush or a pencil, buttering toast or light typing.
  • You’ll work on a series of exercises, starting 1 day postop, to prevent stiffness and regain your range of motion.
  • Most patients start physical therapy after 2-6 weeks, to restore range of motion, then build strength and and endurance as the tissue heals.
  • It’s OK to drive after 1-2 weeks IF you can safely control your car. Use common sense.
  • Your follow-up office visits will be 2 weeks, 6 weeks and about 3-4 months postop to follow your progress and healing. If there are any problems, you’ll be seen more often.

Time out of work depends on your job.

Talk to your employer about returning to work part-time or with restrictions for the first few weeks after surgery. Everyone is different, but generally:

  • Within 1 week: return to an office job, part-time, with minimal use of your arm.
  • 2-4 weeks: seated work with limited us of your arm. No reaching or lifting/carrying >1-2 pounds.
  • 4-12 weeks: if you have a full range-of-motion; can lift up to 10 pounds near the body and start some overhead or repetitive work. Use of your elbow/wrist/hand as tolerated.
  • 3+ months: Expect to work without any particular restrictions; use common sense. Gradually increase as tolerated.

What are the risks associated with this operation:

  • Infection, very rare with shoulder surgery.
  • Medical problems related to anesthesia, like heart or breathing complications.
  • Excessive bleeding or bruising, especially if you’re on blood thinners or bruise easily.
  • Continued pain or stiffness in the shoulder despite everything going as expected.
  • The repaired tendon may not heal as expected, or might tear again in the future (especially if you’re a smoker.)
  • Surgery can’t cure arthritis or replace worn cartilage, but smoothing the rough edges is done to relieve your pain, locking and/or swelling and get you back to the activities you enjoy.
  • Blood clot, which can be dangerous if it travels from your leg vein to your lungs. This is not likely with a shoulder operation. If you have a history of blood clots, we’ll work with your primary-care doctor on prescribing blood-thinners postop to prevent another one

Prepare for your surgery and you’ll have a speedy recovery:

  • See your primary-care physician for preoperative medical clearance (EKG if needed, etc…) and fill out the paperwork for the Surgery Center.
  • If you have chronic health issues, you may need to see your cardiologist or other specialist before surgery.
  • If you take Coumadin, Plavix or other blood-thinner, we’ll contact your doctor who prescribes it. Usually, patients stop taking their blood thinner 5 days before surgery, and re-start the day after.
  • Stop taking any anti-inflammatory medicines (Motrin, Aleve, Ibuprofen, Aspirin…) and supplements like glucosamine 7 days before surgery to prevent excess bleeding (you’ll restart them after the operation.)
  • Please write down any notes or questions, and bring them to your pre-operative visit for us to talk about.