Medical Edge from Mayo Clinic

DEAR MAYO CLINIC:

I'm going to have surgery to repair a large tear in my rotator cuff. What does this surgery involve? How long will the recovery take?

ANSWER:

Depending on your situation, surgery to repair a rotator cuff tear often can be performed using a minimally invasive arthroscopic technique that involves several small incisions, rather than a traditional open procedure using a larger incision. Recovery time varies but, generally, full recovery from rotator cuff surgery takes from six months to one year.

The shoulder moves with the help of two main muscle groups. The top layer is the deltoid muscle. Under that are the thin, strong muscles that surround the shoulder joint and make up the rotator cuff. These muscles connect the upper arm bone with the shoulder blade. They also help hold the ball of the upper arm bone firmly in the shoulder socket.

Over time, the rotator cuff muscles can degenerate. Rotator cuff injuries are seen more commonly in people over 50 years of age. Many injuries result from chronic wear and tear or repetitive stress, rather than one specific incident. With age, a person may also develop calcium deposits within the rotator cuff or arthritic bone spurs that can pinch or irritate the rotator cuff.

Not all rotator cuff injuries require surgery. Many can be effectively treated with physical therapy. But if, as in your situation, the injury involves a large tear in the muscle, surgery can be a good option.

In the past, rotator cuff surgery required a large 2- to 4-inch incision. But over the past 10 years, arthroscopic rotator cuff surgery has become more common and can often be used to repair even large tears. During arthroscopic surgery, the surgeon makes three or four small incisions in the shoulder. A tiny camera is inserted through one of those incisions. Guided by the camera images, the surgeon inserts several instruments about the size of a pencil through the other incisions and uses them to stitch up the torn portion of the rotator cuff. Bone spurs can also be removed during the procedure, if necessary. The surgery usually takes one to three hours.

The surgery is brief, but recovery usually isn't. Recovery after the operation includes two processes: healing from the surgery and restoring the repaired muscle's function and range of motion. The healing period takes two to three months after surgery. During this time, activity may be limited. After that, you'll work with a physical therapist to learn exercises to restore shoulder joint range of motion and strengthen the muscles. For most people, at least six months, and sometimes 12 months, are necessary to maximize the benefit from surgery.

The extent of your recovery will depend in large part on the size of the tear. For small tears, it's possible to recover fully and restore the range of motion a person had before the injury. Larger tears take longer to heal and even after you've fully recovered from surgery, your shoulder function may not return to normal.

Following your recovery from surgery, consider pursuing an active lifestyle that includes activities to gently exercise your rotator cuff without straining the muscles. Toning exercises and gentle strengthening of your shoulders, elbows and arms are particularly helpful for protecting the rotator cuff against future injuries.

Scott Steinmann, M.D., Orthopedic Surgery, Mayo Clinic, Rochester, Minn.

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