Surgical Options for rotator cuff tears

Does my rotator cuff injury need surgery?

The decision to proceed with rotator cuff surgery depends on many factors. These factors include the severity of the rotator cuff tear, the quality of the rotator cuff tissue, your desired shoulder function, and the time since your injury. I have always tried to treat most injuries without surgery, if at all possible. If your shoulder injury is not improving with nonoperative treatment, then you may be a candidate for rotator cuff surgery.

What are the surgical options for rotator cuff surgery?

Rotator cuff surgery is a very generic term that encompasses many different procedures. They can be as minimal as a debridement of the bursa and the rotator cuff with possible removal of any bone spurs called a “smooth and move” procedure. This procedure is normally reserved for partial rotator cuff tears or rotator cuff tears that are old or have poor tissue quality. If you have a complete tear of your rotator cuff with good tissue quality and desire a return to an active lifestyle, you may be candidate for a rotator cuff repair. A rotator cuff repair is most commonly done by stitching the tendon back to its original site on the humerus. In active patients who have a old, complete tear with poor tissue quality, the options are more limited, unfortunately. In those patients, I may offer a reverse shoulder arthroplasty (replacement).

Does rotator cuff surgery involve large incisions?

I perform a vast majority of my rotator cuff surgeries through a small, minimally-invasive approach. This involves the use of arthroscopy. During arthroscopy, I can see the structures of the shoulder in great detail on a video monitor and use small, specialized equipment to repair the torn tissue with small incisions.

What is the recovery time after rotator cuff surgery?

The recovery after rotator cuff surgery depends on the type of surgery performed. I normally tell patients that a rotator cuff repair is a fairly routine procedure for me, but the rehabilitation process can be lengthy for patients. Most patients continue to improve up to 6 to 9 months after rotator cuff repair surgery. Recovery after a “smooth and move” procedure, however, may be faster since the repair is not performed.

What can I do to help my recovery after rotator cuff surgery?

My brother, Dr. Craig Pastor, and I are at the forefront of postoperative pain management. We are studying and implementing evidenced-based approaches to use a variety of pain management techniques to decrease patient’s postoperative pain and improve their overall outcomes. To learn more about our postoperative pain approach, read more here.

What can I expect my outcome will be after rotator cuff surgery?

The outcome after rotator cuff surgery depends on the surgery performed and multiple other factors. These factors include:

· length of time since rotator cuff injury

· tendon quality

· size of the rotator cuff tear

· patient compliance with rehabilitation after surgery

· patient age

· smoking status (of note, I do not perform rotator cuff surgery on patients that are currently smoking due to the poor outcome)

Most patients do very well after rotator cuff surgery. If the rotator cuff repair heals well, most patients achieved full range-of-motion and near equivalent strength of the shoulder.

What are the common complications after rotator cuff surgery?

The most common complications after rotator cuff surgery are a re-tear of the rotator cuff tendon, shoulder stiffness, and shoulder weakness. A re-tear of the rotator cuff tendon is more common after repair of large tears. Shoulder stiffness can usually be alleviated with aggressive shoulder rehabilitation. Shoulder weakness is likely secondary to a re-tear of the rotator cuff tendon. Overall, the complication rate after rotator cuff surgery is very small due, in part, to improved techniques.

Andrew Pastor M.D.