Rotator Cuff Repairs FAQ

Signs and Symptoms

• Recurrent, constant pain, particularly with overhead activities.
• Pain at night that prevents you from sleeping on the affected side.
• Muscle weakness, especially when attempting to lift the arm.
• Catching and grating or cracking sounds when the arm is moved.
• Limited motion.

Diagnosis:
Diagnosis is made through taking a patient's medical history, performing a physical examination and taking X-rays, MRI or Ultrasound.

Treatment:
In most cases, the initial treatment involves:

• Rest: If the tear is due in part to overuse, resting the shoulder may help.
• Non-steroidal Anti-inflammatory Medications: These medications are used to help control pain.
• Strengthening and Stretching Exercises: Exercise may be recommended as part of a physical therapy program.
• Corticosteroid Injections: Corticosteroids can help reduce pain but cannot be repeated frequently because they can weaken the tendon.
• Ultrasound: Ultrasound can enhance the delivery of drugs applied topically or on the skin and has thermal effects that may help in the healing process.

Shoulder arthroscopy is used for rotator cuff repair. Rotator cuff repair is surgery that repairs a torn tendon in the shoulder (tendons connect muscle to bone). The rotator cuff is a grouping of muscles and tendons that form a “cuff” over the shoulder, keeping the arm in the ball-and-socket joint and helping the shoulder to rotate.

The name of the tendon in the shoulder is the “rotator cuff tendon.” Rotator cuff tendon injuries most commonly occur due to the wear and tear associated with aging. Often, what appears as a minor injury causes the tendon to give way. On occasion, a single injury will cause the problem.

Dr. Lassiter will usually recommend rotator cuff repair if you experience pain when using your arm in positions over your head, weakness in the arm and a bone spur or inflammation around the rotator cuff and you have not had a good response to physical therapy.. There are other options available, including no treatment, injections with corticosteroids, physical therapy exercises or pain medication.

In the majority of cases, tendon repair is possible. About five percent of the time, this is not possible. In this situation, the removal of inflammation, scar tissue and bone spurs helps to diminish the pain but overhead use usually does not return to normal.

Rarely will the condition improve without surgery when the tendon tears. Most often, the pain increases and the movement and strength decrease. Fortunately, this usually occurs slowly over the years.

The Surgery Experience
Surgery is performed to suture the torn tendon ends to the bone. During surgery Dr. Lassiter also will remove any inflamed bursa or bone spurs that would delay tendon healing.

Dr. Lassiter recommends an inter-scalene block to numb your arm for surgery. You can then receive less anesthesia and immediate post-operative pain. This usually lasts 21-24hours and will help decrease your pain after the surgery.

Following surgery you will awaken in the recovery room with your arm in a sling. You will remain in the recovery room for two to three hours.Patients go home the same day.

During shoulder arthroscopy, a small camera, called an arthroscope, is inserted near the shoulder joint through a small (usually one-quarter inch) incision. The arthroscope is attached to a video monitor to allow Dr. Lassiter to look inside your joint.

Instead of making a large incision, Dr. Lassiter uses three to four small (about 1/2") incisions. Through one incision, he inserts the arthroscope to look inside your shoulder. He inserts special instruments that allow the removal of scar tissue and bone through the other two incisions. Dr. Lassiter will then insert small metal or plastic screws into the shoulder.

There are sutures attached to the eyelets of the screws. We use special instruments to weave the sutures through the torn tendon. The screws are inside the bone and you cannot feel them. They do not have to be removed. The screws will not set off airport sensors.

How Successful is the Surgery?
Surgery to repair a torn rotator cuff is almost always successful in alleviating shoulder pain. Returning strength to the shoulder is more difficult to guarantee. This type of surgery is successful about 85-95% of the time. Successful surgery is related to patient age, size of the tear, atrophy of the muscles and things such smoking and diabetes. No shoulder operation is 100% successful in every individual but the procedures we perform are reliable and will help restore the potential function in your shoulder. Because of the many variables involved, I can make no guarantees other than to assure you I will deliver the very best medical care possible.

Doctor’s Visits
Your first office visit is two weeks after surgery so that Dr. Lassiter can examine the surgical incision. He will give you additional instructions for exercises and discuss your allowed activity level. Six weeks after surgery, more vigorous use of the shoulder will be allowed. Office visits then occur three, six and 12 months after your surgery.

Returning to Work
For most sedentary jobs, Dr. Lassiter recommends taking a week off from work. When you return to work your arm will be in a sling (for 4 to 6 weeks after surgery), but you should be able to manage as long as you do no lifting, pushing, pulling or carrying.

You are not to raise your arm without help for six weeks after surgery. This allows the tendon to heal in the best possible position. You may begin light duty work involving no lifting, pushing, pulling or carrying, within two weeks after surgery; you may work at waist level and lift 5-10 pounds 3-4 months after surgery. Most patients can tolerate occasional work at shoulder level 3-6 months after surgery, but a return to heavy lifting or overhead use may require 6-12 months.

Rehabilitation
You will see Physical Therapists soon after surgery to maximize your recovery. Then much of your rehab can be done with home exercises.

You will still use the sling and cannot raise your arm up or away from your side. I will see you next six weeks after surgery and you should be able to remove the sling. Doctor visits will continue for six weeks after surgery, as well as visits to the therapist for additional exercises. At the three-month visit, you will begin strengthening exercises.

Complications
The most common complication from rotator cuff repair involves the loosening of the bone screws (suture anchors), which occurs in less than 1% of patients. Dr. Lassiter uses these small metal implants to reattach the torn tendons. There is always a possibility they would have to be removed surgically if they loosen or cause irritation.

Infection can require antibiotic treatment with pills or by injection. Rarely, surgery is necessary. Other possible complications include:

• Wound problems including swelling, bleeding, delayed healing, unsightly or painful scars.
• Bone infection or fracture.
• Joint problems including stiffness or arthritis could occur.
• Failure to achieve the desired result is not strictly a complication but it can be a source of disappointment.
• This operation may result in incomplete motion, strength or function.
• Nerve injury is extremely rare but may result in temporary or permanent, partial or complete loss of feeling and/or movement in the arm.