The Shoulder & Rotator Cuff

The rotator cuff is a group of four tendons that connect four short muscles of the shoulder blade to the humerus (upper arm bone).

These muscles are what control overhead arm movement and help to keep the shoulder stable.

What Causes Rotator Cuff Pain

Impingement or tears are the two main sources of rotator cuff problems. Most common, a condition called impingement, is a disorder which causes narrowing in the space in which the rotator cuff moves. This puts pressure between the rotator cuff and the bone. This most often occurs due to aging as the tendons and muscles of the rotator cuff weaken. Also as the tendons or muscles weaken, an injury or repetitive motions can cause tears across or through the rotator cuff.

Read about shoulder arthroscopy for treatment of impingement.

Rotator Cuff Repair

When conservative treatments fail to provide adequate relief, surgical repair of the rotator cuff is considered. The surgical procedure is performed to re-attach the torn tendon to the humerus. During surgery, an incision is made over the top of the shoulder and the deltoid muscle of the shoulder is opened. The frayed edges of the torn rotator cuff are removed. The torn tendon is then put back onto the humerus. Shoulder motion is checked before the incision is closed to ensure the tendon will not pull away from the bone. Sutures or staples are used to close the incision and are removed two weeks following surgery.

Preparing for Surgery

After midnight on the night prior to your surgery, you cannot eat or drink anything.

What to Expect After Surgery

An IV will be in our arm to administer antibiotics and fluids. An arm sling will keep your shoulder immobilized. An ice pack will help to relieve discomfort and pain medication will be administered to relieve pain. You may be given a “pain pump” or PCA-patient controlled anesthesia pump for the first 1 to 2 days after surgery (see Medication/Pain Control below).

Most patients can return home the day following surgery.

Physical Therapy

While still in the hospital, a physical therapist will visit you to demonstrate proper exercises that will need to be done at home daily. Additionally, 4-6 weeks of therapy supervised by a phyical therapist will be prescribed.

Medication/Pain Control

It is normal for you to have some discomfort especially following exercise or resuming new activities. Pain should be controlled with over-the-counter medications and ice packs can also be used. You may be given a “pain pump” or PCA-patient controlledanesthesia pump for the first 1-2 days after surgery. This device delivers pain medicine into your IV when you want it. You push a button and the medicine is delivered (usually morphine or Demerol). Your surgeon orders the pump set so that you only receive the appropriate amount of medicine needed. The pump is usually set to deliver medicine up to every 8 minutes. Or if you don’t want to bother with pushing the button, the pump can be set to deliver medicine automatically on a set schedule determined by your doctor. As soon as you are eating well, your doctor will switch from IV medicine to pain pills that you take by mouth. This is usually done on the first or second day after surgery.

Going Home

The arm sling should only be removed for exercises and showering. It is very important to continue your exercises as instructed and afterwards apply an ice pack.

While bruising is normal, if the wound becomes red or warm, there is fluid draining from the wound, or if you develop a fever call your surgeon.

Resuming Activities

Returning to a sedentary or office job may be possible as soon as one to two weeks after surgery. If your job requires heavy use of both arms, a full six months of recovery may be necessary. Work which requires heavy manual labor involving lifting, climbing, or the use of heavy equipment is not ever recommended.

Swimming and bicycling can be resumed after three months of recovery. Racquetball, bowling, and golf should be gradually started again after four to six months of recovery. Baseball and tennis requires a minimum of six months recovery. Football, downhill skiing, and heavy weight lifting should be avoided for at least a year following surgery.

Driving is not advised for four weeks following surgery.