If you have a shoulder injury, it may involve the rotator cuff. The rotator cuff is the set of muscles and tendons that position your arm in your shoulder socket, allowing your arm to swing and move in different directions. Overuse or trauma to this area can result in a tear in the tendons that connect your shoulder muscles to your skeletal system, causing limited mobility and pain. Rotator cuff repair surgery may bring hope to people suffering from this condition, but also may seem daunting.
What is the goal of rotator cuff repair?
The objective of rotator cuff repair is to gain both pain relief and regain functionality to the shoulder. In most cases of a rotator cuff tear, surgery may be the best option. The surgery involves reattaching torn tendons to the bone and anchoring them in place, giving the body a chance to heal.[1] Surgery is typically recommended if pain and lack of function remain following attempts at conservative solutions such as shoulder rest, application of ice and heat, anti-inflammatory medications, or physical therapy.
Who may be eligible for rotator cuff repair?
While surgery is not the only option for rotator cuff repair, it is typically recommended for:
- People who have a partial or full thickness rotator cuff tear
- Those experiencing continuous pain with no improvement despite other treatments
- People suffering from rotator cuff pain who play sports or engage in regular physical activities
If you are experiencing these symptoms, talk with your doctor to learn if rotator cuff surgery is right for you.
I need rotator cuff surgery. What happens next?
Do your research.
If surgery is your next step, it is important to do your research. Find a surgeon that you trust and learn about what your surgical options are. Ask questions to ensure you have a good understanding before making a decision.
Do your own research as well. While there are established rotator cuff repair methods, new technology is available that may promote more natural and efficient healing. For example, the Integrity™ Implant System is used to enhance a surgeon’s repair to thicken the rotator cuff tendon and improve healing2. Integrity is comprised of two main things: hyaluronic acid, in the form of HYAFF, which naturally occurs in the body and helps to create an environment for regenerative healing; and a permanent material that reinforces the HYAFF2. With the new Integrity Implant System, your rotator cuff repair has additional strength and healing capabilities to support it. While there are several options of this type of implant available, the Integrity Implant has data that shows it is stronger than the market-leading option2. Speak with your surgeon if you’d like to consider the benefits of adding this system to your rotator cuff repair.
The surgical journey: A brief overview
Prior to any operation, your surgeon will perform a thorough evaluation of your personal situation and create a treatment plan. This plan sets the groundwork for a smooth and successful recovery. Common parts of the assessment plan and surgery experience are included below. Your doctor will make a plan that is personalized for you.
The Evaluation
In order to make a full recovery after surgery, your surgeon will do a baseline evaluation of your shoulder injury (understanding what the injury and your symptoms are like today). This goes beyond an MRI and X-ray, as the medical team will assess the gravity of your injury in relation to your day-to-day life. Knowing a tear is present is the first step, and knowing how it affects you helps shape a plan for healing.
Medical History Review
The medical history review is a key part of the pre-operative process. Your surgeon will inquire about the details of your current medications, your vaccination history, prior surgeries or hospitalizations, and any allergies or adverse reactions to previous treatments. Your surgeon will also be mindful of safety precautions, marking any past symptoms, episodes, drug interactions, or conditions that might affect the surgery or healing after the operation. Preparing for all potential outcomes is paramount to your treatment plan so be as thorough as possible when discussing your medical history.
Setting Expectations
When setting expectations regarding your rotator cuff surgery, clear communication is key. Your surgeon will be open about what he/she can and cannot accomplish given your individual situation. From there, you can jointly determine an expected outcome that is not only beneficial for your health, but possible and realistic. Any questions or concerns regarding potential results should be addressed at this stage.
During the surgery: The main event
It is the day of your operation, and you are at the center of the surgery team’s focus. The aim is for everything to operate like clockwork in a safe and comfortable space.
Anesthesia: Ensuring comfort
Anesthesia ensures a comfortable experience throughout the surgical procedure. There are two types most frequently available for patients: general and regional. General anesthesia will induce sleep for the duration of the surgery. Regional anesthesia, however, involves numbing a single part (or region) of your body while you remain awake. In the end, both options achieve the same goal: to guarantee you’re free of pain during the procedure.
The Rotator Cuff Repair Process
With precision and great care, your surgeon will likely fix the torn rotator cuff tendons using suture anchors[2]. These anchors may be permanent or may dissolve over time. The surgeon will reattach the torn tendon by placing the anchors in the shoulder bone (humerus) and then use the suture that is connected to the anchor to hold the tendon in place. This will ensure the tendon attachment to the bone is properly restored.
Some surgeons may choose to add more products to help strengthen the rotator cuff repair, such as the Integrity Implant. If the surgeon uses Integrity Implant to augment their repair, he/she will place Integrity on top of the tendon that was just repaired and secure it in place. The Integrity Implant System is designed to help the tendon heal more naturally and provides extra strength during the healing process.
After the surgery: The road to recovery
When the surgery is over, your recovery begins. This is a critical phase in the healing process where discipline and determination are crucial to regaining range of motion and strength. In a future blog, we will be featuring common rotator cuff recovery activities. Check back to see what physical therapists recommend!
The Healing Process
Recovery is not a passive process but one of active participation. At first, you may experience some pain and discomfort, but rest assured that this is a natural sign of healing. Leverage surgeon-approved pain management practices to help you cope with this phase of recovery. Another important part of the healing process is physical therapy. Through a series of regular, targeted exercises you can gradually reestablish your shoulder’s mobility and strength.
Common examples of post-operative activities are below, but your doctor and physical therapist will create a plan that is personalized for you.
Initial recovery
In the first weeks following surgery, aim to give your shoulder what it needs the most, i.e., rest. This time is key to restoring the repaired tendons and often determines the final outcome.
Rest and immobilization
The use of a sling will give your arm the necessary support to keep the repaired areas intact. Resting your shoulder promotes the healing process while ensuring no further damage is done to the affected area.
Pain management
As with any surgery, you may experience discomfort as you start to heal. Your surgeon will include pain management in his/her treatment plan for your individual case. This may include a variety of tools including prescriptions or over-the-counter anti-inflammatory medications[3]. Your surgeon will select the best course of treatment while taking your current drug regime, allergies, lifestyle, etc. into consideration.
Preventing strain
Be mindful of workouts and activities that may strain your shoulder. Make modifications to daily tasks as needed and ask for help if you face roadblocks.
Early exercises
As you get back into exercising, don’t do too much too soon. At first, focus on gentle exercises and movements rather than muscle development. These will keep your range of motion and encourage staying limber. Follow your physical therapist’s recommendations to regain strength and range of motion as you heal.
Physical Therapy: The Building Phase
You can typically start physical therapy 2-3 weeks after your surgery with your surgeon’s approval. This is crucial to remedying the injury and working to regain lost functions and abilities.
Personalized plan
Your physical therapist will design a customized program for you, which will be based on the specifics of your injury, your lifestyle, and any job requirements pertinent to your shoulder repair.
Gradual progress
After rotator cuff surgery, the physical therapy activities gradually increase. Early stages begin with passive range of motion exercises, encouraging healing to complete basic tasks such as bathing and dressing. Exercises gradually advance throughout your physical therapy journey with the eventual goal of returning to sports, work, and/or other recreational activities.[4]
Building strength and flexibility
By performing purposeful exercises, you will strengthen muscles around the shoulder and thus develop better mobility in your shoulder joint. This is a progressive outcome consisting of several weeks of physical therapy to make a lasting and meaningful recovery.
Getting Back to Normal: The Integration Phase
While moving through the stages of physical therapy, your shoulder will gain strength and mobility. Recovery is an individualized journey that does not follow a linear path. This is a week-by-week process of progression, and each new accomplishment should be celebrated.
Adapting activities
Late stages of physical therapy include gradually stepping back into the activities you did pre-surgery. You can begin to use your shoulder for gardening, playing pickleball, or exercising your back muscles as you carry groceries.
Long-term maintenance
While the shoulder joint can be significantly better than before, you should be mindful of your limits and need for accommodations, thus preventing future injuries.
Tips for a Good Rotator Cuff Repair Recovery
Talk to medical professionals
Maintain an open dialogue with your surgeon and physical therapist. They can advise you on the best way to move forward and progress as you heal from rotator cuff surgery.
Listen to your body
Don’t push yourself to the point where you may reinjure your shoulder or worsen your progress.
Stay committed to physical therapy
PT provides support for regaining strength and mobility as well as returning to the activities you enjoyed before your injury occurred. Check out some examples of rotator cuff exercises in our video below.
Conclusion
Rotator cuff surgery can bring hope to those dealing with an uncomfortable, painful, or limiting rotator cuff tear. By having a clear idea of your options, the surgical process, and the recovery, you’ll be set up for success. Remember, it’s not a sprint. Recognize that every triumph through the recovery process is a step toward your end goal.
For more information on shoulder health and other related topics, see our website: https://anika.com/patients/solutions/rotator-cuff-repair/.
1. https://www.mountsinai.org/health-library/surgery/rotator-cuff-repair#:~:text=To%20repair%20the%20rotator%20cuff%3A,not%20need%20to%20be%20removed.
2. https://www.mountsinai.org/health-library/surgery/rotator-cuff-repair#:~:text=To%20repair%20the%20rotator%20cuff%3A,not%20need%20to%20be%20removed.
3. https://www.sciencedirect.com/science/article/abs/pii/S1058274616000653
4. https://bostonshoulderinstitute.com/wp-content/uploads/2020/04/PT-Rotator-Cuff-Reconstruction-Final.pdf
