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Rotator Cuff Tear

Complications of Rotator Cuff Surgery

Last modified: 
04/02/2013 - 11:14

Contributing Author: Guy Slowik FRCS

Most individuals recover well and are extremely pleased with the results following rotatar cuff surgery. But complications can occur.

In addition to the risks associated with any major surgical procedure (for example, complications associated with anaesthesia, deep vein thrombosis and infection), there are a number of complications that are unique to rotator cuff surgery. They include:

Stiffness

Shoulder stiffness is a major complication of rotator cuff surgery. Sometimes post-operative stiffness is caused by problems that existed before surgery. Sometimes it relates to the surgery itself. More often, it results from  failure to move the arm adequately after the operation.

If the affected arm isn't moved sufficiently in the weeks after surgery, excess scar tissue can build up. That's why it's so important to begin physical therapy soon after surgery (in line with instruction from the surgeon and physical therapist) and to continue performing the exercises regularly.

If aggressive rehabilitation does not alleviate stiffness, a second operation may be necessary. Sometimes a surgeon can increase flexibility by moving the joint under anesthesia. In other cases, the surgeon must operate to remove the scar tissue that is limiting the shoulder's flexibility. Removing scar tissue also reduces pain related to stiffness.

Re-Injury Of The Rotator Cuff

Some individuals try to do too much too soon after having rotator cuff surgery. Overzealousness can result in re-tearing the surgically repaired tendons. The rotator cuff can also tear a second time because of an inherent weakness in the tendon or bone.

Failed Rotator Cuff Repairs

If the rotator cuff tears a second time, a second operation may be necessary. Repairing a torn rotator cuff a second time is much more difficult. Half of all rotator cuffs that tear a second time cannot be repaired again. In that case, a surgeon might trim the torn edges of the damaged tendon, remove scar tissue, and remove any bone spurs that remain.

Recent research suggests, however, that even individuals who tear a rotator cuff a second time after surgery are better off than they were before the operation. In one study, most patients were stronger, had more flexibility, and reported feeling less pain after the second injury than before the initial surgery. The second tears were usually smaller than the one that first led to surgery.

Some individuals who have had rotator cuff surgery that has failed will be considered for a shoulder joint replacement. This will not be the usual shoulder joint replacement but what is called a 'reverse joint replacement'. It is a technically more difficult procedure and should only be done by a shoulder surgeon who has experience with this operation if it is to succeed. For a normal shoulder replacement to work the rotator cuff needs to be functioning reasonably normally. The reverse shoulder replacement allows the shoulder to function without the normal action of the rotator cuff (relying on the deltoid muscle).

 

 
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From Andrew Maynard - Chair of the University of Michigan Department of Environmental Health Sciences, with help from David Faulkner - 2013 Master of Public Health graduate.