Who Should Have Rotator Cuff Surgery?

If a rotator cuff tendon has torn completely, it usually will not heal completely without surgery. Whether a doctor actually recommends surgery, however, will depend on several factors, including:

• The extent of the injury
• The person's age and general health
• Whether the injury is to the person's dominant shoulder and how much it affects overall function

In most cases, it's best to perform the operation within three months of tearing the rotator cuff.

Usually surgery is recommended in the following circumstances:

• The rotator cuff was torn as the result of an acute injury, accident, dislocation, or fracture, and was healthy beforehand.
• The torn rotator cuff results from chronic degeneration (wear and tear) and does not respond to medication, physical therapy, and other nonsurgical treatments.
• Ongoing pain or weakness in the injured shoulder interferes with a person's ability to perform necessary tasks.

Age itself does not determine whether someone is a good candidate for surgical repair of a torn rotator cuff. But if someone is elderly, and the injury affects his or her non-dominant arm, doctors are more likely to recommend non-surgical treatment. As many as half of all patients with a full rotator cuff tear regain enough strength and flexibility to avoid surgery.

Some rotator cuff tears cannot be repaired. If the tendon has been torn for a long time, the tendon and the muscle sometimes retract (pull back), making it impossible to reattach them.

What Are The Risks Of Rotator Cuff Surgery?

Every operation involves some element of risk. But most people do well and are pleased with the results of rotator cuff surgery.

Complications are rare and include:

• A very small number of surgical patients react adversely to anesthesia. Patients who are obese, or who have heart disease, high blood pressure, or diabetes, are at a higher risk. In rare cases, patients experience allergic reactions to anesthetic agents.
• Infections can occur as a result of any operation. The risk of infection is relatively low in rotator cuff surgery because the incision is small and the procedure is short.
• There is also an extremely small risk of injury to a major nerve that results in partial paralysis or loss of feeling. Some people experience numbness in the vicinity of the shoulder incision, but this usually is temporary.

Preparing For Surgery

Before a patient undergoes surgery, physicians routinely perform a variety of tests to make sure he or she is healthy and fit for surgery. These usually include blood tests, chest x-rays, an EKG (electrocardiogram), and urinalysis.

In addition, physicians may take x-rays of the damaged shoulder and perform other tests, including an MRI, or less commonly, an arthrogram, to assess the extent of the injury.

Patients do not have to donate blood. Transfusions are usually not necessary during or after rotator cuff surgery.

Patients are usually admitted to the hospital on the day of their scheduled operation. Sometimes people with particular health problems, such as diabetes, heart disease or lung disease, are admitted a day early.

The anesthesiologist visits the patient before surgery to discuss the type of anesthetic that will be used.

• Rotator cuff surgery can be performed under general anesthesia, with the patient asleep during the procedure.
• Frequently, a regional (or local) anesthetic is used to block the nerves leading to the arm. In that case, the patient is conscious but cannot feel pain. Usually a sedative is also used, putting the patient in a conscious but dreamy state.
• The choice of anesthetic is based on the type of surgery that is planned, as well as the patient's health and personal preferences.