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Rotator Cuff Tear Repair

AMBULATORY CARE:

What you need to know about rotator cuff tear repair:

Rotator cuff repair is surgery to fix a tear in one or more of your rotator cuff tendons. A tendon is a cord of tough tissue that connects your muscles to your bones. The rotator cuff is made up of a group of muscles and tendons that hold the shoulder joint in place.

Shoulder Anatomy

How to prepare for surgery:

  • Your surgeon will tell you how to prepare for surgery. Tell your surgeon about all medicines you take. Include prescription and over-the-counter medicines. You may need to stop taking some medicines days or weeks before surgery. Your surgeon will give you specific instructions to follow.
  • Arrange to have someone drive you home and stay with you to make sure you are okay. You may be given antibiotics to prevent an infection caused by bacteria. You may be given general anesthesia to keep you asleep and free from pain during surgery. You may instead be given anesthesia to make your shoulder area numb. Tell your surgeon if you have ever had an allergic reaction to antibiotics or anesthesia.
  • Your surgeon may tell you not to eat or drink anything after midnight on the day of your surgery. He or she will tell you what medicines to take or not take on the day of your surgery.

What will happen during surgery:

The tear can be repaired in several ways. Your surgeon will talk to you about the different kinds of surgery. He or she will tell you the kind that is best for you. This will mainly depend on the kind of tear you have and if it is severe.

  • For an open repair or a mini-open repair , your surgeon will make an incision in your shoulder. An open repair may be needed if the tear is large or you need a tendon transfer. You may be able to have a mini-open repair if the tear is small and your surgeon can repair it easily. For either kind of open repair, your surgeon will examine the tendons.
  • For arthroscopy , your surgeon will make small incisions in your shoulder. He or she will put an arthroscope (a camera) into the joint. The camera will show pictures of your joint on a monitor. Your surgeon will put tools into other small incisions in the area. He or she will use the tools to repair the rotator cuff tear.
  • Your surgeon may need to do several things during any kind of surgery. He or she may remove damaged tissue, bone spurs, or a swollen bursa (small sac of fluid around the joint). If the rotator cuff tear is small, he or she may sew it back together. If the tear is big, he or she may attach the tendon to the bone in your shoulder. This can be done with stitches and bone anchors to hold the tendon to the bone. A graft (a piece of another muscle or tissue) may be used to attach and repair the tendon. Your surgeon may reshape your shoulder bone to help it stay in place.
  • Stitches may be used to close the incision. The wound will then be covered with a bandage.

What to expect after surgery:

  • You should expect to feel pain after surgery. This is normal and should get better soon. You will be given pain medicine. Your healthcare provider may also put ice or a cold pack on your shoulder. This treatment may decrease pain, swelling, and muscle spasms.
  • A sling may be placed on your arm to keep it from moving. A pillow attached to the sling holds your arm away from your body. This position decreases pressure on the surgery area. It also helps blood flow to the area to help it heal.

Risks of rotator cuff surgery:

You may get an infection from this surgery or bleed more than expected. You may have nerve damage. If you had an open repair, the muscle that was detached at the beginning may not reattach correctly. Rotator cuff surgery may cause muscles in your shoulder to become weak. This can decrease your ability to use your shoulder. Your tendon may not heal, and your arm and shoulder may be weak and painful. If a graft was used for your repair, you may have swelling and get an infection around the graft. After surgery, tissue around the joint can swell and become stiff. This can cause new pain and problems with moving your arm. The anchor used to fix your tear may press on the tendon and cause pain. Your tendon may tear after surgery. You may need to have surgery again if the new tear causes pain or movement problems.

Call your surgeon or orthopedist if:

  • You suddenly have shortness of breath.
  • The stitches on your shoulder wound come apart.
  • You have new shoulder pain that does not go away, even after you take pain medicine.
  • You have sudden numbness or tingling down your arm.
  • Your surgery area is swollen, red, or has pus coming from it.
  • You have chills, a cough, or feel weak and achy.
  • You have a fever.
  • You have stiffness or pain in your shoulder that is worse and makes you stop your physical therapy.
  • You are vomiting.
  • Your skin is itchy, swollen, or has a rash.
  • You have questions or concerns about your condition or care.

Medicines:

You may need any of the following:

  • Antibiotics help prevent or treat an infection caused by bacteria.
  • Prescription pain medicine may be given. Ask your healthcare provider how to take this medicine safely. Some prescription pain medicines contain acetaminophen. Do not take other medicines that contain acetaminophen without talking to your healthcare provider. Too much acetaminophen may cause liver damage. Prescription pain medicine may cause constipation. Ask your healthcare provider how to prevent or treat constipation.
  • NSAIDs help decrease swelling and pain or fever. This medicine is available with or without a doctor's order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask your healthcare provider if NSAIDs are safe for you. Always read the medicine label and follow directions.
  • Take your medicine as directed. Contact your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him or her if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.

Care for your incision area:

Keep the area clean and dry. Cover it with plastic before you take a shower. Do not take a bath or swim until your surgeon tells you it is okay. Check the area every day for signs of infection, such as swelling, red streaks, or pus. A fever may also be a sign of infection.

Ask about activity:

Your surgeon will tell you when it is okay to use your shoulder and arm. Until then, do not use your arm to lift anything. Do not use your arm to move around, push yourself up from lying down, or to change positions. Your surgeon will tell you when it is okay to drive, go back to work, and do your daily activities.

Apply ice to your shoulder:

Ice may decrease pain, swelling, and muscle spasms. Use an ice pack, or put crushed ice in a plastic bag. Cover it with a towel and place it on your shoulder for 15 to 20 minutes every hour or as directed. Ice may be helpful for 10 to 14 days after surgery.

Use a sling as directed:

You may need to use an abduction immobilizer sling for 4 to 6 weeks after surgery. The amount of time will depend on how severe your tear was. The sling will prevent arm movement while the tendon heals. A pillow attached to the sling holds your arm away from your body. This position decreases pressure on your wound, and helps blood flow to the surgery area. Your healthcare provider will tell you how long to use the sling each day.

Go to physical therapy for as long as directed:

Physical therapy is done in stages. Each stage helps increase motion or strength, and helps relieve or prevent stiffness. Your surgeon and physical therapist will create a plan for your therapy. The plan will be based on your age, health, and recovery goals:

  • Stage 1 is the first 4 to 6 weeks after surgery. Physical therapy may begin soon after surgery. At first, a physical therapist will work with you to do safe exercises that will allow your rotator cuff to heal. This is called passive exercise because your physical therapist will be moving your arm for you. After a few weeks, the therapist may suggest therapy in a pool. The water allows you to move your arm with very little stress on your shoulder. The water also provides resistance. This helps increase muscle strength.
  • Stage 2 continues to weeks 10 to 12. At this stage, your physical therapist may have you start doing active exercises. These are exercises you will do without the help of your physical therapist. Exercises include using your shoulder more. You will begin exercises such as raising and stretching your arm. Do only those exercises that you have been shown. Do them only as often as you are told to do them.
  • Stage 3 continues to weeks 16 to 18. At this stage, you will begin doing exercises that make your shoulder muscles stronger. Your physical therapy will focus on range of motion (ROM) without pain. You will also increase endurance. Your physical therapist will help you stretch and strengthen your shoulder. You may be shown how to use resistance bands. At this stage, you can expect to have about 80% to 90% of your ROM again. This will depend on the type of tear you had repaired. You will need to be able to do strengthening exercises and daily activities without pain to move to the next phase.
  • Stage 4 continues to weeks 16 to 26. This stage is for advanced strengthening. Exercises will target specific areas of your shoulder. You will still not be able to lift your arm over your head or play sports in this stage. Your physical therapist will help you build the strength and stability needed for these activities. The goal is to have full ROM that is the same in both arms, and no pain at rest or during activities. These will be needed before you can return to sports or overhead lifting. It may take up to a year to return to all of your regular daily activities after you have a rotator cuff tear repair.

Follow up with your surgeon or orthopedist as directed:

Ask when you should return to have your stitches taken out. Write down your questions so you remember to ask them during your visits.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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