8. Rotator Cuff Repair Surgery

By Michael S. Erickson, MD

Surgery for a rotator cuff injury is considered elective, meaning that it is the patient's decision whether or not to have surgery. Typically, surgery may be considered as an option for patients who have either:

• Large, full-thickness or high-grade rotator cuff injuries
• Symptoms that have not responded to nonsurgical treatments and injections

See Who Can Have Rotator Cuff Surgery?

Surgery should be scheduled before muscle atrophy and other changes set in. For patients who have had an acute rotator cuff injury, scheduling a surgery within 6 to 12 months of the trauma is adequate.

See What to Do Before Rotator Cuff Surgery

Surgical Approaches to Rotator Cuff Repair

A surgeon can repair a large or complete rotator cuff tear with surgery. What type of surgery is performed will depend on many factors, including the nature of the injury, a patient’s anatomy, and a surgeon’s preference and expertise.

• Open surgery, during which a large incision is made over the shoulder and the deltoid muscle must be detached to access the rotator cuff and then re-attached later.
• Arthroscopic surgery, which requires only a small incision and requires the surgeon to view the surgical area through a small camera called an arthroscope.
• A combination of the two, called mini-open repair, which requires a 3 to 5 inch incision.

See Different Types of Rotator Cuff Surgery

In addition to repairing the major rotator cuff tear, the surgeon may perform debridement, acromioplasty, or other surgical procedures to treat other problems in the shoulder joint.

In This Article:

• Rotator Cuff Injuries
• How Do Rotator Cuff Injuries Occur?
• Rotator Cuff Injuries: Symptoms
• Rotator Cuff Injuries: Causes and Risk Factors
• Rotator Cuff Injuries: Diagnosis
• Rotator Cuff Injuries: Initial Treatment
• Rotator Cuff Injections
• Rotator Cuff Repair Surgery 

Debridement and Acromioplasty

Partial degenerative rotator cuff tears are sometimes also treated surgically with a procedure called debridement. During debridement the damaged tissue is removed in the hopes of spurring new tissue growth and repair.

Debridement is often done in combination with acromioplasty, the removal of a small portion of the scapula bone’s acromion. By removing bone, acromioplasty can provide more space for soft tissues and relieve painful shoulder impingement.

Rehabilitation

Following surgical repair a patient must participate in a rehabilitation program. This rehab program follows similar steps to those outlined for nonsurgical management, as follows:

1. Pain control and shoulder immobilization for approximately 6 weeks.
2. Physical therapy to restore the shoulder’s range of motion and strength. 
3. Integration of specific activities and sports participation, as the doctor deems appropriate.

The total recovery time is usually about 6 months.

See Rotator Cuff Surgery Recovery

Other References:

• Peterson SA, Murphy, TP. The timing of rotator cuff repair for the restoration of function. Journal of Shoulder and Elbow Surgery, 2011;20(1):62-68
• Cuellar VG, Lerebours F, Strauss E. Nonoperative Management: Who, When, and What? Operative Techniques in Sports Medicine. 2012;20(3):207-212
• Drakos MC, Rudzki JR, Allen A, Potter HG, Altchek DW. Internal Impingement of the Shoulder in the Overhead Athlete. Journal of Bone and Joint Surgery. 2009;91(11):2719-2728
• Tendinopathy Treatment: Where is the Evidence? Skjong CC, Meininger AK, Ho SSW. Clinics in Sports Medicine. 2012;31(2): 329-350
• Hudson VJ. Evaluation, Diagnosis, and Treatment of Shoulder Injuries in Athletes. Clinics in Sports Medicine. 2010;29(1):19-32
• Rutten M, Maresch BJ, Jager JG, Blickman JG, van Holsbeeck MT. Ultrasound of the rotator cuff with MRI and anatomic correlation. European Journal of Radiology.2007;62(3):427-436
• Van Thiel GS, Moore JR. Rotator Cuff Injury. First Consult. Elsevier, 11 Oct. 2013. Web.
• Lashgari, Cyrus, Redziniak, Danial. Upper Extremity: The natural history of rotator cuff tears. Current Orthopedic Practice. 2012. 23.