Rotator Cuff Surgery
Double-Row Rotator Cuff Repair
Overview
The recommended treatment for a rotator cuff tear depends on the nature of the tear, size of the tear, and the individual patient.
Many patients with partial thickness tears, small or even medium sized tears can respond well to physical therapy and may avoid surgery.
Surgery recommendations are individualized to each patient’s needs and expectations. Typically, surgery is recommended for patients who do not improve with therapy. It is also recommended for younger patients, more active patients and individuals with large tears.
For additional information, please see the rotator cuff repair guide:
Arthroscopic Rotator Cuff Repair
Arthroscopic repair is the least invasive method used to repair a torn rotator cuff. A camera is placed inside the shoulder, and anchors are used to secure the tendon back to the bone. The procedure is typically performed on an outpatient basis. Repair techniques are dependent upon the pattern of rotator cuff tear. A double row repair as depicted in this video is a commonly performed technique.
Superior Capsular Reconstruction
In some circumstances a rotator cuff tear may no longer be repairable. If this is the case and the joint is largely free from arthritis, a Superior Capsular Reconstruction (SCR) may be performed. This arthroscopic procedure utilizing cadaver tissue to take over the functional role of the torn rotator cuff tendons.
Reverse Shoulder Replacement
In settings of a massive rotator cuff tear that is not repairable or when a rotator cuff tear is associated with shoulder arthritis a reverse shoulder prosthesis may be considered. The replacement is designed to aid with restoration of shoulder stability and function in the setting of a compromised rotator cuff.
Postoperative Pain Management
Nerve Block - Nerve blocks are an option to aid with pain management for arthroscopic shoulder surgery. The anesthesiologist performs this before surgery. A numbing medication is injected around the nerves going to the shoulder. This can make the shoulder and arm numb so that pain is decreased following surgery. The anesthesiologist will provide more detailed information about the nerve block on the day of surgery and you are encouraged to ask questions. The medication will typically last 12-18 hours.
Rebound Pain: Please be aware that the numbing medication can wear off quickly. To decrease a rebound effect it is recommended to begin narcotic medications as soon as you experience pain and wean off as able.
Narcotic Pain Medication (Oxycodone/Hydrocodone) - You should plan to take this medication as needed. Many patients find that they need it regularly for the first two days and then less afterwards. We like for patients to be off of this narcotics after a few weeks. You may switch to over the counter pain medications such as Tylenol if you no longer require narcotic pain medicine.
Nerve Medication (Gabapentin) - This is intended to aid with pain control over the first three days. The most common side effect is drowsiness.
Acetaminophen (Tylenol) - You should take Tylenol around the clock for the first 5 days following surgery to aid with pain control. Typical dosing is 500-1000mg every 8 hours. Do not exceed 3000mg in a 24-hour period. After the first few days you can wean off all pain medications as you are able.
Anti-Inflammatories (Ibuprofen/Naproxen/Meloxicam) - The first phase of rotator cuff healing is inflammation. Please avoid these medications for the first 4 weeks following surgery. After this time frame anti-inflammatory medications are encouraged for pain control.
Sling Application
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Early Rotator Cuff Rehab
Successful outcomes with rotator cuff surgery are highly dependent on appropriate postoperative rehabilitation and compliance with physical therapy. In this video Dr. Richard Hawkins provides a brief overview of rotator cuff tears, outlines passive range of motion exercises, sling care as well as active range of motion exercises for later use in the rehabilitation process.
Additional Resources
American Academy of Orthopaedic Surgeons FAQs regarding rotator cuff surgery
The importance of proper Physical therapy following surgery cannot be overstated. Click here to schedule with OrthoArizona PT
Arthroscopy Association of North America Patient information website - preparing for surgery, surgical recovery, etc.