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Surgical options for a rotator cuff repair

Not every rotator cuff tear need to be fixed with shoulder surgery. There are people who have large tears of the rotator cuff but still have reasonably good function and relatively little shoulder pain. However, there are also some people who have a torn rotator cuff that causes a lot of shoulder pain and very little use of the shoulder. Everyone is different and the role of surgery in the treatment of a torn rotator cuff is different for each patient. The main goals of rotator cuff surgery include relieving the shoulder pain, improving the strength and increasing the function of the shoulder. You and your doctor will be able to decide how much this type of surgery may improve your shoulder pain and function, and each decision is made on an individual basis.

The types of shoulder surgery that can be done for a torn rotator cuff include:

  • Repair of the torn rotator cuff and removal of the excess bone from the acromion through a typical surgical incision.

  • Removal of the excess bone from the acromion by first using an arthroscopic technique and then performing a rotator cuff repair through a small surgical incision.

  • Removal of the excess bone from the acromion and also performing a rotator cuff repair with the arthroscope.

There are advantages and disadvantages to each of these surgical techniques. Surgeries that are done with arthroscopic techniques leave smaller scars, but they can be more technically demanding and take longer to conduct than other types of shoulder surgery. There are also some patients and some rotator cuff tears that can not be fixed by using only arthroscopic techniques. In this situation, a regular incision needs to be made in order to complete the repair safely.

Torn rotator cuff - the tendons hav pulled away from the bone.  This can be the cause of shoulder pain.

The tendons that have pulled away from the bone are immobilized by the surgeon...

Shoulder surgery to repair a torn rotator cuff.  The tendons are fixed back to their original position.

...and then fixed back in their original position

Although surgeons can fix most rotator cuff tears, there are some tears that are so large that they can not be fixed. In these situations, the tendon that is torn is usually scarred down and has retracted so that it cannot be pulled out to its original length very easily. Unfortunately, surgeons are usually unable to determine if a rotator cuff tear is not repairable before the shoulder surgery. An attempt is usually made to repair the torn rotator cuff, only to find that either the tissues do not have enough strength left to hold surgical sutures, or they are scarred and shrunken. When this happens, the ends of the rotator cuff tendons are trimmed of any loose fibers and the excess bone from the underneath of the acromion is removed.

Rotator cuff surgery options for tears that usually cannot be fixed include:

  • Trimming of the torn rotator cuff tendons, which is called "debridement" by doctors.

  • Replacement of the shoulder joint

Removing the excess bone from the acromion and trimming the edges of the torn rotator cuff tendons can relieve a lot of shoulder pain and help restore a lot of motion in many patients with an irreparable cuff tear. If a patient continues to have a lot of pain and stiffness in the shoulder joint, then a shoulder replacement may be considered as an option for relieving shoulder pain.

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