What is the Surgery for Rotator Cuff Tear

The rotator cuff is a group of muscles and connective tissues (tendons) that surround the shoulder joint and keep the upper arm bone (humerus) in the shoulder socket. A tendon is the place on a muscle where it attaches to a bone. Surgery may be done to repair a partial or complete tear in the rotator cuff that cannot be treated by nonsurgical methods.

The exact procedure that you have depends on your injury. If you have a partial tear, you may have surgery to reattach a tendon to the humerus. If you have a complete tear, you may have surgery to sew the two sides of the tear back together. Surgery may be done through small incisions using an operating telescope (arthroscope), through a larger (open) incision, or through a combination of both.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines or materials used during the procedure.
• Damage to nerves, blood vessels, or shoulder muscles.
• Permanent loss of full shoulder movement (stiffness).

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Other instructions

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• Plan to have someone take you home from the hospital or clinic.
• If you will be going home right after the procedure, plan to have someone with you for 24 hours.
• Ask your health care provider how your surgical site will be marked or identified.
• You may be given antibiotic medicine to help prevent infection.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An IV tube will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
  • A medicine that is injected into an area of your body to numb everything beyond the injection site (regional anesthetic).
• Your surgeon will move your shoulder to observe your injury.
• If you are having arthroscopic surgery:
  • Small incisions will be made in the front and back of your shoulder.
  • An arthroscope will be inserted through these incisions to examine the inside of your shoulder and plan the surgery.
• If you are having open surgery, a wider incision will be made in your shoulder.
• Some of the muscle covering your shoulder (deltoid) may be moved to expose your rotator cuff.
• Bony growths that might interfere with healing will be removed.
• Your rotator cuff will be trimmed around the area where it has torn away from your humerus.
• If your rotator cuff is completely torn, the split ends will be sewn back together.
• Anchoring inserts will be placed into your humerus in the area where the tendon has torn away from the bone.
• The torn end of your rotator cuff will be re-attached (anchored) to your humerus using stitches and small screws.
• Your incisions will be closed with sutures.
• The incision in your skin will be covered with a bandage (dressing) and medicine.
• Your arm will be placed in a sling.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
• You may have some pain. Medicines will be available to help you.
• Do not drive for 24 hours if you received a sedative, or until your health care provider approves.

Surgery for Rotator Cuff Tear, Care After

Refer to this sheet in the next few weeks. These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After the procedure, it is common to have:

• Swelling.
• Pain.
• Stiffness.
• Tenderness.

Follow these instructions at home:

If you have a sling:

• Wear the sling as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the sling if your fingers tingle, become numb, or turn cold and blue.
• Do not let your sling get wet if it is not waterproof.
• Keep the sling clean.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
• Keep your bandage (dressing) dry until your health care provider says it can be removed.

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your dressing. If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Managing pain, stiffness, and swelling

• If directed, put ice on your shoulder area.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move your fingers often to avoid stiffness and to lessen swelling.
• Raise (elevate) your upper body on pillows when you lie down and when you sleep.
  • Do not sleep on the front of your body (abdomen).
  • Do not sleep on the side that your surgery was performed on.

Driving

• Do not drive for 24 hours if you received a medicine to help you relax (sedative) during your procedure.
• Do not drive or operate heavy machinery while taking prescription pain medicine.
• Ask your health care provider when it is safe for you to drive.

Activity

• Do not use your arm to support your body weight until your health care provider approves.
• Do not lift or hold anything with your arm until your health care provider approves.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do exercises as told by your health care provider.

General instructions

• Do not use any tobacco products, such as cigarettes, chewing tobacco, or e-cigarettes. Tobacco can delay healing. If you need help quitting, ask your health care provider.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have a fever.
• You have more redness, swelling, or pain around your incision.
• You have more fluid or blood coming from your incision.
• Your incision feels warm to the touch.
• You have pus or a bad smell coming from your incision.
• You have pain that gets worse or does not get better with medicine.

Get help right away if:

• You have severe pain.
• You lose feeling in your arm or hand.
• Your hand or fingers turn very pale or blue.