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
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 usually adequate.
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 requires a large incision made over the shoulder. The deltoid muscle must be detached to access the rotator cuff and then re-attached later.
- Arthroscopic surgery requires only a small incision. The surgeon views the surgical area through a small camera called an arthroscope.
- A combination of the two, called mini-open repair, requires a 3 to 5 inch incision.
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.
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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.
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:
- Pain control and shoulder immobilization for approximately 6 weeks.
- Physical therapy to restore the shoulder’s range of motion and strength.
- Integration of specific activities and sports participation, as the doctor deems appropriate.
The total recovery time is usually about 6 months.