Outlook For The Future

Despite technological advances that enable surgeons to perform some procedures using arthroscopic tools, rotator cuff surgery can still be a major operation. Most individuals recover well and are extremely pleased with the results.

However, in addition to the risks associated with any major surgery, there are a number of complications that are unique to rotator cuff surgery. They include:

• Stiffness

• Re-injury of the rotator cuff

• Failed rotator cuff repairs

Stiffness

Shoulder stiffness is a major complication of rotator cuff surgery. Sometimes post-operative stiffness is caused by problems that existed before surgery. More often, stiffness results from a 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 right after surgery 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.

In rare cases, individuals who have had rotator cuff surgery must later have joint replacement surgery. In this procedure, the surgeon replaces the "ball" and "socket" of the shoulder joint with metal and plastic parts. This operation may become necessary when the head of the humerus rubs for a long time against the acromion, wearing away the cartilage that acts as a cushion between bones. The result is a severe case of arthritis.

Shoulder fusion surgery is a rare procedure that is done only as a last resort. This surgery severely restricts movement of the shoulder. It allows for only limited - but pain-free - use of the shoulder. As a last resort, it is sometimes preferable to the pain and weakness of a failed rotator cuff repair.