The rotator cuff is a group of four tendons and their attached muscles that stabilize the shoulder and allow you to raise and rotate your arm. The shoulder is a ball-and-socket joint with three main bones: the upper arm bone (humerus), the collarbone (clavicle), and the shoulder blade (scapula). The rotator cuff helps keep the ball of the arm bone seated into the socket of the shoulder blade.
When the tendons and muscles of the rotator cuff are overly stretched or damaged, the shoulder may begin to hurt. Patients with a rotator cuff tear usually have a dull ache in their upper arm in the area of the deltoid muscle. Neck pain on the same side may develop over time, as well as dull headaches. Patients may experience weakness or “popping” in the shoulder. and have difficulty with over-head shoulder activities (tennis, swimming, getting dressed). Night pain is a common finding with rotator cuff injuries, and may result in the inability to sleep.
If you’ve torn your rotator cuff, your doctor may recommend surgery if your pain does not improve with nonsurgical methods. These include exercises using light weights and rubber bands, anti-inflammatory medications and massage to relieve discomfort. Continued pain and inability to perform the activities of daily living are the primary indications for surgery, and if you’re very active and use your arms for overhead work or sports, your doctor may also suggest surgery.
Surgery to repair a torn rotator cuff most typically involves sewing the torn edges of the tendon to their insertion on the top of the humerus, but partial tears may only require a trimming or smoothing procedure (debridement) to remove loose fragments of tendon, thickened bursa, and other debris from around the shoulder joint.
In open shoulder surgery, a surgeon makes an incision in the shoulder to open it and view the shoulder directly while repairing it. However, most tears can be fixed via arthroscopic surgery. Arthroscopic rotator cuff repair is a minimally invasive technique for repairing a damaged rotator cuff. Using a small fiberoptic camera, the surgeon repairs the rotator cuff through 2-3 small incisions (portals) in the shoulder. Arthroscopic techniques result in less pain and stiffness, thus leading to a faster initial recovery time. Because arthroscopic tools are thin, your surgeon can use very small incisions, rather than the larger incision needed for standard, open surgery.
Surgery for rotator cuff repair requires significant recovery time. The patient will most likely wear a sling for four to six weeks. It will take approximately 3 months for initial healing of the tendon, but patients may begin light activities, such as writing and typing, almost immediately after surgery. Light weightlifting and shoulder strengthening begins 10-12 weeks post-operatively. You may not have significant pain relief or an increase in motion for several months following rotator cuff surgery. The healing process, coupled with physical therapy takes an extended period of time, sometimes up to six to nine months for a full recovery.
About Dr. Karas
Spero Karas, MD, is the Director of the Orthopaedic Sports Medicine Fellowship Program and an Associate Professor of Orthopaedic Surgery at Emory University. Dr. Karas is an internationally recognized expert in his field, which includes sports medicine, surgery of the shoulder and knee, and arthroscopic surgery. He has been recognized as one of America’s “Top Orthopaedic Doctors” in Men’s Health Magazine April 2007 and “Top Sports Medicine Specialists for Women” in Women’s Health Magazine. Atlanta Magazine has named him “Atlanta’s Most Trusted Sports Medicine Specialist” for the past eight years.
Dr. Karas came to Emory in 2005, after serving as Chief of the Shoulder Service and team physician at the University of North Carolina in Chapel Hill. He currently serves as team physician for the Atlanta Falcons, as well as a consulting team physician for Emory University and Georgia Tech athletics. He cares for patients and athletes of all levels: professional, collegiate, scholastic, and recreational.