How Long To Recover From Rotator Cuff Repair Surgery

Ofttimes Asked Questions

Why am I still having symptoms subsequently rotator cuff surgery?

The almost common causes of pain subsequently rotator cuff surgery are (1) that the shoulder is still recovering from the surgery itself and (2) the shoulder has gotten stiff due to lack of movement. Information technology is well known that rotator cuff surgery is a major operation where the rotator cuff tendons (Figure 1) are sewn back to the upper arm bone (humerus) (Figures 2 and 3).

The other major reason patients have pain after rotator cuff surgery is due to stiffness of that shoulder. It is common after rotator cuff surgery to have some stiffness due to the fact that the performance caused the arm to be held without motion for some time. It is important afterward the surgery to protect the rotator cuff repair for several weeks while it heals, and during this fourth dimension it is very common for the shoulder to get stiff to a lesser or greater degree. Your dr. and concrete therapist can keep an heart on this for you and let you know if your stiffness is the expected amount or too excessive. Often times the stiffness tin be treated, and the hurting resolves.

It takes the repaired rotator cuff tendons about 6 weeks to heal initially to the bone, iii months to course a relatively strong attachment to the bone, and most six to ix months earlier the tendon is completely healed to the bone. About patients who have had rotator gage surgery will tell yous that it takes virtually nine months earlier the shoulder feels completely normal. This observation is supported by a report showing that in patients who take had rotator cuff surgery, strength in the shoulder muscles is non fully recovered until nine months after the surgery. As a upshot, information technology is normal to expect some connected symptoms of pain or soreness after rotator gage surgery for several months.

How do I treat the stiffness?

You should always follow the directions of your surgeon after surgery, since some tears need more time to heal than other tears. The all-time thing is to mind to your doctor equally well as the physical therapist involved in your care. We tell our patients that water ice is helpful for the pain, along with pain medicine of some sort, such as acetaminophen (east.one thousand. Tylenol), anti-inflammatory medications (eastward.g. aspirin, ibuprofen, naproxen, etc.), pain relievers (non-narcotic or narcotic) and even prednisone by oral fissure (eastward.g. cortisone dose packs). You should take these medications only at the management of your physician. We usually recommend that during the outset three months the emphasis in physical therapy and with your home program should be on regaining motion in your fingers, wrist, elbow and shoulder. We tell patients they accept the rest of their lives to get stiff, but during the beginning iv months after rotator gage surgery, the major goal should be largely to regain motion in the shoulder. Stiffness in the shoulder can be the crusade of pain months after the surgical repair, so it is important that stiffness be addressed fifty-fifty months or years after the surgery.

How much therapy should I have after surgery?

Your surgeon tin reply this since they are the ones who know how much work had to be done to repair the tendons. The doctors tin can prescribe therapy based on the work done during the operation. If more than one tendon had to be repaired or if the tendon tear is a big tear, the surgeon may recommend that the therapy progress slower to allow more fourth dimension for healing; on the other hand, if the tear is small, they may allow a little more motion before than usual after the surgery.

Diagram showing permitted degrees of shoulder movement. Described under the heading How much therapy should I have after surgery?

It is possible to accept too much therapy, and that is usually experienced equally lots of pain later on the therapy session or pain for days subsequently the therapy session. It is of import that the physical therapist has a dialogue with yous to make certain that the exercises are done at a proper stride for your particular surgery. We typically recommend physical therapy only twice a week. Withal, we recommend that patients stretch on their own the other days when they practice not see the therapist. Sometimes concrete therapy with the therapist three times a week is indicated, and this should exist discussed with your doc and concrete therapist. Similarly, it is typically not necessary to stretch more than one time or at about twice a mean solar day with a home plan. Lastly, if strengthening exercises are causing yous pain, we recommend that you exercise not do the exercises over 60 degrees of summit of the shoulder (Effigy 4). This is because the rotator cuff begins to have increased stress above this level, and information technology can worsen the hurting if the shoulder is irritated already. We recommend that you ice the shoulder after any practice program to keep the pain under command.

What if I feel a tear or pull in therapy?

Information technology is not uncommon to have a small "twinge" or "pull" in physical therapy, which typically does not mean that the rotator cuff repair has failed. Normally these pocket-sized twinges are usually cipher to worry about. Information technology is non really known what causes them, but it is believed that information technology may be scar tissue being stretched or the shoulder joint moving around normally in the socket. It would be rare for the therapy to really cause a repaired tendon to tear, as will be discussed later on.

How practice I know if the tendon repair has torn over again?

Information technology is not easy to tell if the rotator cuff tendon repair has failed or not. The symptoms of pain or loss of strength are mutual after rotator cuff surgery while the tendons are healing, and minor setback are to be expected. We practise non recommend a magnetic resonance scan or other studies when these setbacks occur for several reasons. The first reason is that magnetic resonance imaging afterward a surgical repair of the rotator cuff does not accept the same accuracy in determining whether tendons are torn. If an MRI is performed, we recommend that it be performed with dye in the afflicted shoulder (arthrogram) with a needle under x-ray or Cat scan guidance by a radiologist. This examination is chosen an arthrogram-MRI and may exist positive if the tendon has non had enough time to heal or if parts of the tendon take not healed to os. As a result, inside three months later a rotator cuff repair, it is mutual for the dye to leak through the tendon since information technology has not completely healed. After this period of time, the caste of tear in the tendons tin be adamant best with this report.

What do I do if my tendon has non healed?

The reality of rotator gage surgery is that while nigh tendons heal back to the bone after surgery, not all repaired tendons heal completely, and some do not heal at all. There are many reasons for this lack of healing with surgery. The kickoff is that the rotator cuff tendons are big tendons which may have too extensive harm to heal. The rotator cuff tendons are big, and in that location are four of them. Each rotator cuff tendon is as thick as your piddling finger and every bit wide as 2 to three fingers. The chance that the tendons volition heal with surgery is directly related to how big the tear in the tendons was before surgery. How to decide the size of the rotator cuff tendon tear will exist discussed below.

The second reason that the tendons may not accept healed with surgery is that these tendons begin to clothing out in nearly humans showtime around the age of xxx, and the amount of wear and tear varies from person to person for reasons nosotros practise non understand. This vesture of the tendons occurs in some people simply not in others. By the age of l, many people have some vesture of their rotator gage tendons.

When rotator cuff tendons tear prior to any surgery, in that location are two ways they can tear. The showtime is that in that location is an injury that pulls the tendon off the os. When this happens, there is still some tendon left to repair with very little tendon missing. Even so, in many cases when the tendon tears with minimal trauma, the reason the tendon tore in the first place was because it already had some violent due to wear and tear over the years. This wear and tear over time is the second way the tendon tin tear. This type of tear is best described as a tear that occurs in a manner analogous to "wearing a hole in the seat of one'south pants"; the tendon just gets thinner and thinner over time until there is a pigsty there (called an "attritional tear"). This type of rotator gage tendon tear typically happens without the person being enlightened that it is happening.

The thing that is strange about this type of rotator cuff tear is that they can occur and not cause any problems until the tear gets large. These "vesture a hole in your pants" tears can be whatsoever size from the size of a pinhole to "massive" tears where there is little tendon left. In these tears, the edge of the tendon at the pigsty is thin, and it is difficult to stitch it back together. If one tries to repair a pigsty in the tendon that is the size of one fingernail or smaller, it is easier to repair than a larger hole. In large holes caused by this type of damage (attritional or "clothing a hole in your pants" type of tear), the rotator cuff tissue effectually the edges is not as sturdy, and one is asking the tissue to fill up up a hole where there is really no tendon. For this reason, the major factor in determining whether a rotator cuff tear can heal is how large the hole was to being with prior to the surgery. The larger the rotator cuff tear before surgery and then the higher the failure rate of surgery.

How practise you lot describe the size of tendon tears?

The start way to depict tears of the rotator cuff tendons is whether tears are part of the way through (called "fractional thickness") or all the manner through the tendon (called "full thickness". The tears of the rotator cuff tendons tin be partial thickness (similar sawing through a rope role of the way) (Effigy 5) or they tin can progress to tears all the mode through the tendon (like sawing all the way through a rope) (Figure ii). In one case a tear is all the way through the tendon (called "full thickness"), the next outcome to consider is the size of the hole in the tendon. As the tendons tear more, they tin can be of any size (depth and width).

The normal anatomy of the shoulder and rotator gage tendons are demonstrated in Figure 6. Full thickness tears of the rotator cuff are described as small, medium, big or massive (Figures 7, viii, 9 and 10). Since well-nigh rotator gage tendons are about as broad as three of your fingers, a pocket-sized tear would be one the size of your fingernail or smaller (less than one centimeter of tendon torn) (Figure 7). A moderate size full thickness tear through the tendon would be 1 that is the size of three fingernails (most one centimeter in one management and iii centimeters in another). Usually tears of this size mean the whole tendon width is pulled off of the bone (Effigy 8). A big tear is one that would hateful the tendon is torn from the knuckle to your fingertip; this is called a big or massive tear (Figures nine and 10). It is as well possible to tear more than ane tendon completely. The size of the tear is very important as it determines the chances that the tendon will heal with surgery.

What are the chances a tear will heal with surgery?

There accept been many studies that tell the states estimate odds of tendons healing with surgery depend upon the size of the tendon [one, 3, 7, 13]. Information technology has been demonstrated that modest full thickness tears the size of a fingernail (one centimeter) (Figure vii) heal in a majority of cases, simply approximately 5% will not heal for the reasons mentioned in the discussion above. For full thickness tears that are moderate size (one to three centimeters), the re-tear rate is around twenty% (Figure 8). For large tears (three by five centimeters), the re-tear charge per unit is approximately 27% (Figure 9). For massive tears (where 1 tendon is largely or completely gone or more than one tendon is torn), the re-tear rate is anywhere from l to 90% [8, 14] (Figure 10). The reason for this loftier failure rate with large to massive tears is because there is a hole too large to be filled by stretching the remaining tendon, and the edges of the tendon will not hold the stitches used in the repair of the tendons.

So what do I practise if a rotator cuff tear fails?

Usually a tendon repair fails because information technology was going to fail and non considering of a bad surgery or bad therapy. The reality is that rotator cuff surgery is not perfect, and non all tendons will heal completely with surgery. Once a tendon has failed an attempted surgical repair, the odds are that it volition exist hard to repair over again and to go information technology to heal. In some cases, the tear may exist small plenty after a failed repair to exist successfully repaired, but the exact risk of failure with further surgery is related to how large the tear is at that time. The larger the tear, the less likely it can exist successfully repaired a 2nd fourth dimension. In most cases a second attempt at repairing the tendon is not going to be successful unless the tear is small.

If the tendon has re-torn and cannot exist repaired with further surgery, at that place is still hope for the part of the shoulder; the shoulder is not doomed and all is non lost. At that place are two myths about rotator cuff tears. 1 myth about rotator cuff tears is that the shoulder is doomed if the tendon is not repaired. The reality is that some people can take good range of motion and function with torn rotator gage tendons. The degree of symptoms subsequently a failed rotator cuff repair depends upon many factors. The typical symptoms of shoulders with un-repaired tendon tears are weakness with lifting above shoulder level or away from the trunk. The symptoms can often be controlled by watching i's activities, maintaining a good range of movement of the shoulder, and beingness careful almost how much lifting one does with the shoulder. Basically one tin can do whatever activity he/she chooses every bit long as information technology does not injure. We recommend that the patient lets their symptoms be their guide to activity level.

The 2nd myth about accept a rotator gage tear that is likewise large to repair is that the shoulder is doomed to become arthritis or to gradually lose office. In that location is no fashion to predict what charge per unit the shoulder will have whatsoever problems or if it volition accept any bug at all. There is only 1 written report which has suggested that the shoulder with no rotator cuff tendons may develop arthritis over fourth dimension [10]. This study was not conclusive, so information technology is currently believed that being active does non lead to degeneration of the shoulder when there are irreparable tears. Nosotros encourage people with torn rotator cuff tendons that cannot be repaired to be equally agile equally possible within the limits of their pain and weakness.

What about patching upward the hole?

For decades there have been many attempts at finding some tissue or something manufactured to put in the hole of the torn rotator cuff tendon to help information technology heal. Unfortunately most of those attempts have failed as they do not regenerate or heal the hole in the rotator cuff tendons. Things that take been used unsuccessfully to patch the hole in the by include a person'southward ain tissue (called "autografts" and include iliotibial band and biceps tendon), a cadaver or human donor tissue (called "allografts" and include iliotibial band and posterior tibialis tendons from the leg), tissue from animals (called "xenografts" and include sterilized pig-gut mucosa) and more recently patches made from culture cells (homo skin cells, fibroblast scaffolds). In most instances these have no restored function and strength to the shoulder, and they should be considered experimental at this time. We do not recommend them in most instances, particularly in tendon tears that have had previous surgery that has failed. Some physicians recommend these patches in tears that are very large, but the failure rate is exceedingly high. At that place is currently no known or proven advantage to using patches in the repair of torn rotator cuff tendons.

What virtually tendon transfers?

A tendon transfer is an performance where the tendon of another muscle effectually the shoulder is moved to supersede the rotator cuff tendon. There are a couple of tendon transfers that have been described for this purpose [2, 9, xi]. The first is a large muscle in the back of the shoulder chosen the "latissimus dorsi muscle." While this is a large muscle, the tendon is actually very sparse and not very large. While this performance was once advocated for patients with large rotator cuff tears with pain, the results were not as practiced as initially reported. This operation is helpful for just a minority of patients and has lost favor amid shoulder surgeons [12].

A second musculus and tendon transfer that was described one time was the use of the deltoid muscle and tendon equally a buffer or spacer for the space where the rotator cuff tendons were located. This operation was largely a failure and is no longer recommended.

What about shoulder replacement?

Shoulder replacements for patients with rotator cuff tears can be successful merely patient eligibility continues to change and evolve. Typically shoulder replacements are reserved for patients with torn rotator cuffs who also take arthritis of the shoulder joint. The replacements are not oft used for patients who have but loss of movement alone, and we tell patients that the replacements are indicated mainly for reducing pain in the shoulder. Nonetheless, as there are increasing improvements in shoulder replacements, this may change and should be discussed with your md.

In that location are several kinds of shoulder replacements bachelor for patients with arthritis and painful rotator gage tears. Each type has its advantages and disadvantages depending on the historic period of the patient, the action level of the person, and the amount of damage to the shoulder. In some instances it might be best to supersede the shoulder with a more conventional shoulder replacement. A relatively new prosthesis called the contrary prosthesis has had some promise in patients with arthritis and torn rotator cuff tendons that are not repairable. These operations are by and large very expert for pain relief and practice consequence in some improvements of motion. The pluses and minuses of these procedures should be discussed with your physician.

References

DeOrio, J.K. and R.H. Cofield, Results of a 2nd attempt at surgical repair of a failed initial rotator-cuff repair. J Bone Joint Surg Am, 1984. 66(four): p. 563-vii.
Chaffai, M.A. and M. Mansat, Anatomic basis for the construction of a musculotendinous flap derived from the pectoralis major muscle. Surg Radiol Anat, 1988. 10(4): p. 273-82.
Harryman, D.T., second, et al., Repairs of the rotator cuff. Correlation of functional results with integrity of the cuff. J Bone Joint Surg Am, 1991. 73(7): p. 982-9.
Rokito, A.S., et al., Forcefulness after surgical repair or the rotator cuff. J Shoulder Elbow Surg, 1996. 5(1): p. 12-seven.
Rokito, A.S., et al., Long-term functional outcome of repair of large and massive chronic tears of the rotator cuff. J Bone Articulation Surg Am, 1999. 81(7): p. 991-7.
Davidson, P.A. and D.W. Rivenburgh, Rotator cuff repair tensions equally a determinant of functional result. Journal of Shoulder and Elbow Surgery, 2000. 9(6): p. 502-506.
Jost, B., et al., Clinical effect after structural failure of rotator cuff repairs. J Bone Joint Surg Am, 2000. 82(3): p. 304-fourteen.
Motamedi, A.R., et al., Accuracy of magnetic resonance imaging in determining the presence and size of recurrent rotator cuff tears. J Shoulder Elbow Surg, 2002. xi(ane): p. vi-ten.
Iannotti, J.P., et al., Latissimus dorsi tendon transfers for irreparable posterosuperior rotator cuff tears. Factors affecting outcome. J Bone Articulation Surg Am, 2006. 88(2): p. 342-viii.
Zingg, P.O., et al., Clinical and structural outcomes of nonoperative management of massive rotator cuff tears. J Bone Joint Surg Am, 2007. 89(9): p. 1928-34
Derwin, K.A., et al., Rotator cuff repair augmentation in a canine model with use of a woven poly-L-lactide device. J Os Joint Surg Am, 2009. 91(5): p. 1159-71.
Nove-Josserand, L., et al., Results of latissimus dorsi tendon transfer for irreparable gage tears. Orthop Traumatol Surg Res, 2009. 95(2): p. 108-13.
Slabaugh, M.A., et al., Does the literature confirm superior clinical results in radiographically healed rotator cuffs after rotator cuff repair? Arthroscopy, 2010. 26(iii): p. 393-403.
Kluger, R., et al., Long-term Survivorship of Rotator Gage Repairs Using Ultrasound and Magnetic Resonance Imaging Analysis. Am J Sports Med, 2022.

Source: https://www.hopkinsmedicine.org/orthopaedic-surgery/specialty-areas/shoulder/treatments-procedures/failed-rotator-cuff-repairs.html