Rotator cuff repair is a surgical procedure that aims to reattached the torn edge of the tendon to bone. It usually follows attempts at treating the condition with nonsurgical options, such as injections, anti-inflammatories, and physical therapy. The decision to proceed with surgery depends on multiple factors which include but not limited to:
- Factors related to the tear itself
- How big is it?
- how many tendons are involved?
- How far has the torn edge pulled from the bone?
- Does it have enough healing potential?
- has the tear caused irreversible joint or muscle damage?
- Factors related to the patient
- How healthy is the patient overall?
- Is the patient ready, able, and willing to follow instructions during the recovery phase?
The rotator cuff is a group of four tendons, and tears can be as little as a partial tear of one tendon, or can involve all four. The torn edge of the torn tendon can be still in place waiting to be reattached in place, or it could have pulled as far as 2 inches away making attempts at repair much more difficult. The tendon substance may be intact and healthy, or it could be degenerated and weak in such a way that it may not be able to hold a stitch. The muscle working the tendon may be perfectly healthy but has no tendon to pull on, or it may have become degenerated, and replaced with fat tissue so much so that even if the tendon heals, the muscle may be too weak to pull on it. When the tendon and the muscle are degenerated, the joint may lose balance and the ball may gradually slip out of the pocket and cause irreversible damage (cuff tear arthritis), making any attempt at tendon repair futile. So all the above mentioned factors need to be carefully weighed when considering surgery.
On top of that, it is important that the patient understands that surgery is only the first step. All I can do is mobilize the torn tendon, freshen its edge, prepare the bone to accept it, and attach the tendon to the bone. What I cannot do is heal it. Repair and healing are two different things. The stitches and anchors used are meant to hold the tendon to the bone for the tear to heal. It is the patient’s body that does the healing. So, it only makes sense that if the stitches are pulled on before the tendon has healed, one can only expect the repair to fail. So, the patient’s role is to protect the repair long enough for it to heal. The patient can and is required to protect it by avoiding actively raising the arm or actively using it beyond what is allowed as determined during the surgery. This usually involves a form of shoulder immobilization that usually lasts anywhere from 4-8 weeks following the surgery. Respecting this restriction is the most critical step during the recovery period.RI following Cuff Repair
What To Expect After Surgery
Discomfort after surgery is expected and may decrease with taking pain medicines as prescribed.
The arm will be placed in an immobilizer for a defined period of time, and is not to be removed except upon instruction of the therapist and upon direction from the surgeon.
Physical therapy rehabilitation program may include the following:
- During the first period, the shoulder is rested. Exercises of the elbow, wrist, and hand are encouraged.
- After a short period of time, passive exercises that move your arm may be done about 3 times a day (a machine or physical therapist may help the joint through its range of motion).are started under supervision.
- Active exercises may start 6 to 8 weeks after surgery.
- Strengthening exercises, beginning with light weights and progressing to heavier weights, can start at around 3 months after surgery.
During this whole process, the most valuable player is the patient. It is the patient who determines that surgery is warranted; it is the patient that has full control of the recovery period; and it is the patient’s body that determines healing (assuming a successful and strong repair was achieved); and it is the patient who sets his/her goals and expectations.