Surgical Explanations
Rehabilitation Protocols
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Rotator Cuff Repair
The rotator cuff is a collection of 4 muscles and their corresponding tendons that surround and cover the humerus (upper arm bone). The rotator cuff allows the arm to rotate, move upward and acts as a stabilizer for the humerus within its joint. With injury, or sometimes long term wear and tear to the shoulder, the rotator cuff can tear (see video link here), either partially or through the entire thickness of the tissue. When this occurs, patients may find it difficult to lift their arm above their shoulder, sleep on the affected side or place their arm and hand behind their back.
An outpatient rotator cuff repair by Dr. Bryan is a two-step procedure involving arthroscopic viewing of all the structures within the shoulder, including the rotator cuff, and then a small 1-2 inch open surgical incision on the end of your shoulder (for the actual repair of the tear).
Arthroscopy is a surgical procedure used to visualize, diagnose, and treat problems within a joint. During an arthroscopic examination, Dr. Bryan makes a very small incision in the skin and then inserts a pencil-sized probe that has a camera and light at the end. The camera and light enlarge and illuminate the structures inside the joint and allow Dr. Bryan to view the interior of your joint on a monitor in the operating room.
After arthroscopic visualization of the shoulder is completed and Dr. Bryan determines that your rotator cuff can be repaired, a slightly larger incision, approximately 1-2 inches long, will be made at the point of your shoulder. Through this small incision, Dr. Bryan will once again visualize the tear and its contours. If necessary, he will “clean up” the edges of the torn cuff. Next, he will place a small suture anchor into the head of the humerus bone. This anchor has permanent sutures (stitches) already attached. Dr. Bryan will capture the torn ends of the rotator cuff with the sutures and use them to tie the torn edges back together. Depending on the size of the tear, more suture anchors may need to be placed into the humerus. These anchors are made of a variety of materials including memory shaped polymers and titanium. A second row of fixation devices, called pushlocks, secure the repaired rotator cuff onto the contours of the humerus for added protection of the repair.
Once the edges of the torn cuff are placed back together the incision is closed with sutures and bandaged.
The shoulder will be extremely painful for several days to weeks following the surgery. You may find that remaining in a semi-sittting position, even while sleeping, is the best option. You will be in a large sling upon waking from surgery. This sling is for comfort. You may take your arm out of the sling and straighten your elbow and move your wrist. You may even move your arm in small circles or pendulum type exercises. You will find that sleeping with the sling is most comfortable for 1-2 weeks following surgery. You will also want to wear your sling whenever you are out in public to protect the shoulder. You will do only very basic exercises for 1 month following surgery. Physical therapy will begin approximately 3-4 weeks following surgery. Recovery from a rotator cuff repair is intense and time consuming and can take upwards to 9 months. The length of recovery depends on many factors, including the size of the tear, date of injury to the shoulder, and patient motivation for rehabilitation. |
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