What Is Done In Rotator Cuff Surgery?

During rotator cuff surgery, the patient is put in a half-sitting position, with the head supported. Most operations are performed under general anesthesia, where the patient is asleep. Sometimes 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 given, putting the patient in a conscious but dreamy state.

Rotator cuff surgery usually takes one to two hours.

Types of procedures include:

• Impingement surgery

• Rotator cuff repair

• Arthroscopic surgery

Impingement Surgery (Also Called Acromioplasty Or Subacromial Decompression)

If the space between the upper arm and the part of the shoulder blade known as the acromion is too narrow, the rotator cuff cannot move freely. Rotator cuff tendons get pinched between the two bones, gradually damaging the rotator cuff.

To resolve this problem, the surgeon shaves a small portion of bone from the underside of the acromion, giving the tendons more room to move and preventing them from being pinched. The surgeon also removes any bone spurs and either excises or removes swollen or irritated bursa.

Impingement surgery is sometimes performed to relieve severe, chronic tendinitis that does not respond to nonsurgical treatment. Impingement surgery is also done as part of most rotator cuff repair surgeries.

Rotator Cuff Repair

In order to repair a torn rotator cuff, the surgeon reattaches the damaged tendon (or tendons) to the upper arm (humerus). (Some rotator cuff injuries involve more than one torn tendon.)

This surgery involves several key steps:

• In order to gain access to the injured rotator cuff, the surgeon makes a two- to three-inch incision in the shoulder, then cuts through the deltoid muscle.

• The surgeon removes any scar tissue that has built up on the tendon.

• The surgeon carves a small trough at the top of the upper arm, then drills small holes through the bone.

• Finally, the surgeon sews the tendon to the bone, with the sutures going through the tiny holes in the upper arm. (Sometimes a surgeon will use permanent anchors to attach the tendon to bone.)

During this operation, the surgeon also removes bone spurs and releases any ligaments that are pressing on the tendon. If a bursa is inflamed, the surgeon excises or removes it. The surgeon also may remove a small portion of the acromion to make sure the repaired rotator cuff has enough room to move.

Afterwards, the patient's arm is placed in a sling. With time, healing occurs, as scar tissue connects the tendon to bone. Because tendons receive such poor blood supply, this is a slow process.

Arthroscopic Surgery

Arthroscopic surgery is a technique for performing an operation using pen-shaped instruments with a miniature video camera attached to the end.

• The surgeon makes a small incision in the shoulder about the size of a buttonhole.

• He or she then inserts the thin tube that contains the tiny video camera and surgical instruments.

• The surgeon performs the operation with these remotely controlled instruments while watching on a video screen.

Because arthroscopic surgery requires only limited surgical access, the incision is much smaller than is necessary for open surgery, resulting in fewer risks. The patient's recovery time is also shorter.

However, because repairing a torn rotator cuff can be a complicated procedure, it is often performed as an open procedure. However, arthroscopic repairs are becoming more common, especially for small size tears.