The rotator cuff is the name collectively given to the four tendons that surround the humeral head and function to stabilize the shoulder and move and power the arm. Tendons attach muscle to bone. The four tendons that comprise the rotator cuff include: the supraspinatus, the infraspinatus, the subscapularis, and the teres minor.
The rotator cuff is usually injured in one of two ways: either acutely in a trauma such as a slip and fall or in a chronic manner as a result of cumulative wear-and-tear over time.
The rotator cuff can be injured in a wear-and-tear type manner where the tendon is frayed and becomes thin over time. It can also be injured in such a way that it tears apart (imagine a hole in the tendon) or detaches from its bony attachment. Additionally, the rotator cuff very commonly becomes inflamed and irritated without a structural injury which can result in significant shoulder pain.
Depending on the type of injury present, there are both nonoperative and operative options to repair a rotator cuff injury. If the rotator cuff tendon is irritated or inflamed, typically nonoperative options such as physical therapy, activity modification, and possibly a steroid injection constitute the first line of treatment. If the rotator cuff is torn, especially if it is torn completely (termed a “full-thickness tear”) frequently surgery is the optimal intervention. Rotator cuff repair surgery reattaches the torn tendon to the bone, re-creating the anatomy the way that it was before the injury occurred.
The decision to undergo shoulder surgery is typically made by patients who are looking to improve their quality of life. Rotator cuff tears are painful and debilitating and oftentimes lead to a significant reduction in the quality of life. Broken sleep with resultant daytime drowsiness, irritability, and the inability to participate in desired activities often motivate patients to elect to undergo rotator cuff repair surgery. Studies show again and again that patients with rotator cuff tears who undergo rotator cuff repair surgery tend to have significant improvement in factors that dramatically impact their quality of life such as reduction and elimination of shoulder pain, improvement of function in terms of being able to perform activities of daily living and participate in sporting activities, and improvement in quality and duration of sleep. If your torn rotator cuff is leading to bad days and bad nights, it is worthwhile to consider surgery.
Surgery may not be the only option to repair a damaged rotator cuff. If the rotator cuff is irritated or inflamed, frequently physical therapy can be quite helpful in treating this condition.
The vast majority of rotator cuff repair surgeries are performed as outpatient surgeries which means that the surgery is performed and then the patient goes home the same day to recover at home.
The answer to that question is different for every patient. The general requirements in order to be safe to drive following a rotator cuff repair surgery include: 1. You must be comfortable and not be on any narcotic pain medications while driving. 2. You must feel comfortable not wearing your sling while driving (you should not have a sling on while driving). 3. In general, you must feel safe and that you are able to maneuver your vehicle safely.
Usually, patients reach these milestones anywhere from 1 week to 8 weeks following rotator cuff repair surgery.
I use one phrase over and over to describe recovery following a rotator cuff repair surgery: a marathon. You are in a sling for approximately 6 weeks during which time you are not allowed to actively move or use your shoulder (passive range of motion of the shoulder only) and then you gradually progress from there with the first 6 weeks or so of formal physical therapy focusing primarily on regaining full range of motion. Strengthening exercises typically start 3 months after rotator cuff repair surgery. I tell my patients that they should expect the full recovery from rotator cuff repair surgery to take up to one year.
Formal physical therapy following rotator cuff repair surgery typically starts about 6 weeks after surgery, but many patients choose to do at least a few sessions of physical therapy right after their surgery to work on very gentle passive range of motion exercises and to try and address secondary issues like trapezius muscle soreness and neck pain that tend to pop up after shoulder surgery with the extended period of time in a sling.
Rehab after a rotator cuff repair surgery is typically months-long. For best results, most patients choose to attend a session or two of physical therapy each week for a few months after surgery while doing daily home exercises as recommended by their therapist and then graduate to a home exercise “maintenance” program.