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Rotator Cuff Repair

Stephen M. Desio, M.D.

  1. After your rotator cuff surgery, there will be a bulky bandage over your shoulder and your arm will be in a sling. There may be a small pillow attached depending upon the extent of the surgery. This sling takes the pressure off the repaired tendons. It is to remain on at all times unless told to you by Dr. Desio that it may be removed.
  2. The sling may be worn outside your clothes. To dress, place the operative arm in a button type shirt first. Then insert the nonoperative arm and button shirt. Then, place arm in sling and secure straps of sling until snug.
  3. A Cold Therapy Cold Pack may be placed on top of your bandage after surgery. This is connected to a cooler that you will fill with ice and water. Cryotherapy is also known as cold therapy. This is the treatment of pain and/or inflammation by lowering the temperature of the skin over the affected area. It is probably the oldest form of pain control! In addition, it can significantly improve swelling after an injury or surgery. 
  4. You may remove your bandage and take a shower with your stitches 2 days after surgery as long as there is no drainage from the incision sites. If you notice drainage from the sites, hold off on getting them wet until they are completely dry. Place BandAids over the incisions once per day until they are fully healed. Do not soak incisions in water. No swimming or bath for 7 days after surgery.

Caution: The pad should never be placed directly on the skin as it can cause frostbite or skin injury. Always have clothing between your skin and the pad.

The pad is placed on your shoulder after the bandage is applied. The blue tube is connected to the cooler and ice water will automatically circulate through the pad to decrease pain and inflammation from surgery. The pad and cooler are yours to keep. Do not bring them to the office unless you are having problems with them.

TIP: Freeze small water bottles and place them in the cooler with water instead of ice cubes

Medications

  • You may have had a nerve block before surgery. This may provide numbness of your shoulder, arm, and hand for up to 36 hours. When the nerve block wears off, expect an increase in your pain.
  • You will be given a prescription for a pain killer that is a narcotic. This is usually Vicodin, Oxycodone, or something similar. This is very strong medication and should be weaned as soon as possible to reduce the potential side effects of this medication.
  • If you feel the prescription it too strong or you do not need it, Tylenol , Advil , Ibuprofen, or Aleve may be used instead, as long as you do not have any allergies to these medications
  • Pain Management is very important during the first few days after surgery. To prevent the pain from getting ahead of you, take either your prescription or over the counter pain medication regularly for the first 24 hours until the nerve block has worn off.
  • A stool softener is recommended i.e. Colace. One of the most common side effects of pain medication is nausea and constipation.
  • If you experience nausea, it is most commonly a side effect of the narcotic pain medication, and the anesthesia. Please call the office and we will phone in medication for the nausea.
  • Although blood clots are rare, you should take a baby Aspirin a day, starting the day of surgery, for 2 weeks after surgery to reduce the risk.
  • Contact the office if you have any redness or excessive drainage at the incision sites. Bruising is normal and will develop a few days after surgery.

Contact the office if you have any redness or excessive drainage at the incision sites.

EXERCISE: Depending on the extent of the tear, your physical therapy will usually begin 5 days after the surgery.

The shoulder has the greatest mobility of any joint in the human body. Recovery from surgery is dependent upon the size of the tear, quality of tissue, quantity of tissue to repair, and general health of each patient. Complete recovery from rotator cuff surgery can take 6 months to one year. Patience and hard work will result in better chances of success.

If you have any questions, please call: Stephen M. Desio, M.D.
Office: (508) 363-6363

 

More Information

Rotator Cuff Injuries

Four muscles in the shoulder that when injured or damaged can lead to sleepless nights, pain, and weakness.

The most common ways of injury to the rotator cuff are trauma, such as a fall on the outstretched hand, repetitive overload to the tendon by activity, or bone spurs cutting into the tendon.

Symptoms commonly begin with pain over the upper arm that is worse with reaching overhead, lying on your side, reaching behind your back, and weakness.

The rotator cuff has a very limited capacity to heal on its own and therefore treatment is often required to improve symptoms. This usually begins with a short period of rest, followed by a rehabilitation program focused on mobility, and strength to improve function. Steroid injection can be used if significant inflammation is present and interferes with the ability to engage in the exercise program. Two thirds of patients will improve with these modalities alone, and thus this is the first phase of treatment.

If symptoms persist, MRI is utilized to evaluate the rotator cuff for tears. Most commonly injured is the supraspinatus tendon. This is the muscle that allows you to put on a jacket, reach into the kitchen cabinet and get out the dishes, put a gallon of milk in the refrigerator, or pour a pot of coffee. Because the tendon is spring loaded, full tears commonly separate or retract. The more the retraction, the more serious the tear. If these tears are not addressed, atrophy will ensue and the tears will frequently get larger over time.

Surgical repair is performed arthroscopically and consists of stretching the tendon back out to it’s attachment point and repairing it back to the humerus greater tuberosity that it pulled off from. Traditionally, the shoulder was immobilized in a sling for up to 6 weeks before starting physical therapy to protect the repair. The downside of this approach was a high rate of postop stiffness, called frozen shoulder. We pioneered an accelerated rehab program for rotator cuff 25 years ago that reduced this immobilization down to just 5 days and actually lowered to postop stiffness rate.

Quality of the rotator cuff tissue has been a major determinant of success of the surgery, as well as the recurrent tear rate. The larger the tear and degree of separation, the higher the recurrent tear rate – that can approach 50 percent!

Innovation in rotator cuff surgery revolves around the use of biologics to reduce the risk of recurrent tears. CuffMend is an acellular, dermal allograft that is placed upon the repair to effectively double the thickness of an atrophic tendon and reduce the risk of recurrent tears. We have been effectively utilizing this technology over the past 2 years with great success to enhance patient outcomes for the most serious tears.

We remain committed to utilizing the best technology to remain innovators in rotator cuff surgery.