(1988). Some estimates that show, after 60, more than 50 percent of people have a rotator cuff tear. Patients often spend two hours in the recovery room and about two days in the hospital after surgery. "Self-assessment questionnaires document substantial variability in the clinical expression of rotator cuff tears." Do you need surgery for partial rotator cuff tears? For more information: Rotator Cuff Injuries - Clinical Practice Guideline (CPG) | American Academy of Orthopaedic Surgeons (aaos.org). It can take up to a year for you to have full use of your shoulder again. In severe cases, you may need surgery. Return to work after rotator cuff surgery. In general the exercises are best performed by the patient at home. If you keep ignoring your pain and discomfort, youll only extend the healing period and cause further damage to your shoulder joint. This involves covering the humeral head with grafted tissue to hold the tendon in place in the joint. Most people regain their range of motion and strength after 4 to 6 months. This surgery typically requires four stages of physical therapy as you recover. People over the age of 40 who dislocate their shoulders are likely to have cuff tears. Rotator cuff surgery is often performed in a major medical center that performs these procedures on a regular basis. One method for diagnosis is ultrasound. "Rotator cuff." Harryman D. T. 2nd F. A. Matsen 3rd et al. In this photo, the white round structure on the right is the top of the humerus. While this is a large muscle, the tendon is actually very thin and not very big. In addition, your doctor may use one of the following: If you dont treat your rotator cuff tear, you may experience weakness, or you could lose the ability to move your shoulder permanently. Recovery is a long process in order to allow the rotator cuff to heal. J Shoulder Elbow Surg 15(1): 30-9. Continued pain is the main indication for surgery. After surgery, youll wear a sling for 4-6 weeks. One of the major goals of rotator cuff surgery is to relieve much of this stiffness. I slept in a recliner for one week. A systematic review of electromyography studies in normal shoulders to inform postoperative rehabilitation following rotator cuff repair. Rotator cuff tears. Goldberg B. Mack L. A. and F. A. Matsen 3rd (1995). The rotator cuff tendons can be irritated or damaged. This wear of the tendons occurs in some people but not in others. If you dont do anything about a torn rotator cuff, you can have more serious problems over time. Oral pain medications are usually needed only for the first two weeks after the procedure. On the day of surgery or on the day after the physical therapist teaches the patient gentle range of motion exercises. There are a couple of tendon transfers that have been described for this purpose [2, 9, 11]. We tell our patients that ice is helpful for the pain, along with pain medicine of some sort, such as acetaminophen (e.g. There are two main causes of rotator cuff tears: injury and wear (degeneration). X-rays of the shoulder are usually normal in the presence of cuff disease. Your shoulder hasnt improved after 6 to 12 months Youve lost a lot of strength in your shoulder and find it painful to move You have a tear in your rotator cuff tendon 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 it heal. Initially pain medication is administered usually intravenously or intramuscularly. Radiology 157(1): 205-9. Taking an anti-inflammatory medicine before bed can help to reduce the pain after your rotator cuff surgery. Reproduced with permission from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. The rotator cuff attaches the humerus to the shoulder blade and helps to lift and rotate your arm. Your doctor and physical therapist can keep an eye on this for you and let you know if your stiffness is the expected amount or too excessive. When these tissue grafts are required, shoulder surgeons usually perform a mini-open repair, rather than an arthroscopic repair. Baseball updates, scores, schedules and stats on the Rangers. Their proper use lies in the balancing of their pain relieving effect and their other less desirable effects. Rehabilitation following surgical repair of the rotator cuff: a systematic review. WebMD does not provide medical advice, diagnosis or treatment. Some physicians recommend these patches in tears that are very large, but the failure rate is exceedingly high. The drain is usually removed on the second day after surgery. understand and accept the risks and alternatives of surgery and. For two tendon tears, the success rate is still greater than 70%. The shoulder is a ball-and-socket joint: The ball, or head, of the upper arm bone fits into a shallow socket in the shoulder blade. Most people who follow these steps notice that their shoulder pain is better in 3 to 6 months. There may be a snapping sensation and immediate weakness in your upper arm. But it also can happen suddenly if you fall on your arm or lift something heavy. If you're feeling pain from a torn rotator cuff, you know it can be every bit as bad as it sounds. The typical symptoms of shoulders with un-repaired tendon tears are weakness with lifting above shoulder level or away from the body. Shoulder exercises are best performed gently several times a day on an ongoing basis. First, an arthroscopy of the glenohumeral joint (the ball-and-socket portion of the shoulder joint) is performed to identify and treat other associated problems, such as a biceps tendon injury, loose bodies or a torn labrum. Physical therapy to make your shoulder muscles stronger. This patient was suffering from rotator cuff tendinosis and a partial-thickness cuff tear.. Tendinosis represents a structural change in the tendon at a microscopic level. If an MRI is performed, we recommend that it be performed with dye in the affected shoulder (arthrogram) with a needle under x-ray or CAT scan guidance by a radiologist. If the exercises are uncomfortable difficult or painful the patient should contact the surgeon promptly. One myth about rotator cuff tears is that the shoulder is doomed if the tendon is not repaired. Most important: Dont lift your arm at the shoulder until your doctor says its OK. Most patients have a functional range of motion and adequate strength by 4 to 6 months after surgery. This type of rotator cuff tendon tear typically happens without the person being aware that it is happening. If the patient has questions or concerns about the course after surgery the surgeon should be informed as soon as possible. Box 356500 We do not recommend a magnetic resonance scan or other studies when these setbacks occur for several reasons. The video box below is a playlist of 4 shoulder exercise videos. "Rotator cuff tears become increasingly common after 40 years of age, even in people who have no shoulder pain at all," Candy says. Stretching of the shoulder rotator cuff muscles is easily performed both as treatment for inflammation and as a warm-up before activity. These activities may increase the chance of repeat rotator cuff tear. The rehabilitation after rotator cuff surgery is carried out largely by the patient. The timeline for this portion of PT is variable, but it can take several months before you are fully discharged from therapy. In most cases these exercises can be done in the patient's home with little equipment. A systematic review of electromyography studies in normal shoulders to inform postoperative rehabilitation following rotator cuff repair. Find adoctor at HSS who treats rotator cuff tears. A. S. B. Lippitt et al. In the hands of an experienced surgeon rotator cuff surgery can be a most effective method for restoring comfort and function to shoulders with rotator cuff tears in a healthy and motivated patient. Youll need to rest your shoulder as you recover, but if you keep it still for too long your connective tissue can thicken up and get tight. That one that goes all the way through the tendon or pulls the tendon off the bone. If physical therapy has not effectively restored strength and function, then surgery is the only option. The bursa allows the rotator cuff tendons to glide freely when you move your arm. We encourage people with torn rotator cuff tendons that cannot be repaired to be as active as possible within the limits of their pain and weakness. The rotator cuff tendons cover the head of the humerus (upper arm bone), helping you to raise and rotate your arm. Rotator cuff repair is the surgery used to repair a tear in one of these tendons. People who do repetitive lifting or overhead activities are also at risk for rotator cuff tears. The smaller and more recent the tear, the better your chances of being pain-free and having a full range of motion. It has been demonstrated that small full thickness tears the size of a fingernail (one centimeter) (Figure 7) heal in a majority of cases, but approximately 5% will not heal for the reasons mentioned in the discussion above. acute tears of otherwise healthy tendons or. Norquist B. M. B. 2005 - 2022 WebMD LLC. In some cases, they might need to take out small pieces of tendon or bone that are stuck in your shoulder joint, or remove small areas of bone or tissue to give your tendon more room to move. Recovering from a rotator cuff repair requires both persistence and patience. If a patient tries conservative treatments and continues to have pain and difficulty with activities after two or three months, he or she may consider surgery to repair the tear. It can even jolt you awake from a sound sleep. The first reason is that magnetic resonance imaging after a surgical repair of the rotator cuff does not have the same accuracy in determining whether tendons are torn. The effectiveness of the procedure depends on the health and motivation of the patient the condition of the shoulder and the expertise of the surgeon. This website also contains material copyrighted by third parties. Tears tend to get larger with time. These operations are generally very good for pain relief and do result in some improvements of motion. Alberta Evidence-based Practice Center: Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears., Massachusetts General Hospital, Orthopaedics, Sports Medicine: Shoulder -- Torn Rotator Cuff., American Society for Surgery of the Hand: Rotator Cuff Injuries., HSS: Rotator Cuff Tears, Injuries and Treatments.. Ask your doctor for exercise ideas to help strengthen your shoulder area. This balances your muscles. This is because the rotator cuff begins to have increased stress above this level, and it can worsen the pain if the shoulder is irritated already. The second reason that the tendons may not have healed with surgery is that these tendons begin to wear out in most humans beginning around the age of 30, and the amount of wear and tear varies from person to person for reasons we do not understand. In these tears, the edge of the tendon at the hole is thin, and it is difficult to sew it back together. Occasional visits to the surgeon or therapist may be useful to check the progress and to review the program. http://shoulderarthritis.blogspot.com/2013/12/the-rotator-cuff-tear-book.html. Soft-tissue treatments for associated shoulder and neck musculature for convenience. Its also called a complete tear or a full-thickness tear. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Its a common injury, especially in sports like baseball or tennis, or in jobs like painting or cleaning windows. Nonsurgical treatment options may include: A cortisone injection may relieve painful symptoms. http://shoulderarthritis.blogspot.com/ For information:Questions and Answers for Patients Regarding Elective Surgery and COVID-19. your medical provider may suggest surgery if a tear is large or discomfort lasts longer than 6 months. A rotator cuff tear is a common cause of shoulder pain and disability among adults. Continue to seek full shoulder variety of movement in all planes. When the rotator cuff does not function normally, due to weakness, fraying or tearing, it may not function correctly to keep the humeral head (or "ball" at the top of the arm bone or humerus) centered on the glenoid (or "socket" attached to the shoulder blade). When there is sufficient quantity and quality of tendon tissue, the torn edge of the cuff tendon is anchored to the humerus from which it was torn so that healing back to the bone can take place. The second myth about have a rotator cuff tear that is too large to repair is that the shoulder is doomed to get arthritis or to gradually lose function. While this operation was once advocated for patients with large rotator cuff tears with pain, the results were not as good as initially reported. Your surgeon can answer this since they are the ones who know how much work had to be done to repair the tendons. Bandages cover the incision. While prompt surgery is usually recommended for acute cuff tears in generally healthy shoulders exercises may be helpful in maintaining the flexibility and strength of joints with long-standing cuff tears. Your shoulder joint may deteriorate too. Tears that develop slowly due to overuse may also cause pain and arm weakness. J Shoulder Elbow Surg 9(5): 368-72. For instance, for skiing, with a ski pole held firmly with one hand at the basket and one hand on the deal with, with the arms held out straight, bring the pole from the waist to above the head, repeating the motion gradually to the limits of the variety of motion. Subacromial bursitis may cause catching and pain in the shoulder but shoulder strength is maintained. How to determine the size of the rotator cuff tendon tear will be discussed below. Strengthening exercises begin after the 6- to 10-week healing period. Usually the patient is shown how to stretch the shoulder forward and out to the side preventing stiffness and adhesions. He teaches as an Assistant Professor of Orthopedics at Emory School of Medicine in Atlanta, Georgia. The patient's motivation and dedication are important elements of the partnership. J Bone Joint Surg Am 73(7): 982-9. In severe cases, you may need surgery. Because of this, passive stretching by the therapist and icing may still need to be performed. Many patients return to full strength and have complete range of motion four to six months after surgery. The types of injuries most likely to cause cuff tears are those in which the elevated arm is forced downward (an eccentric force) or when the shoulder attempts a sudden jerky lift (a concentric force). Goldberg B. Gradually increase the weight to above the head. After rotator cuff repair the patient needs to plan on being less functional than usual for twelve or more weeks after the procedure. It is important that the physical therapist has a dialogue with you to make sure that the exercises are done at a proper pace for your particular surgery. Thomson S, Jukes C, Lewis J. The other is a complete tear. Attempting to sleep in lift recliner. They may also examine your neck to makesure that the pain is not coming from a pinched nerve, and to rule out other conditions, such as arthritis. The torn tendon is then reattached to the bone with the use of suture anchors and sutures. As the tendons tear more, they can be of any size (depth and width). The symptoms can often be controlled by watching one's activities, maintaining a good range of motion of the shoulder, and being careful about how much lifting one does with the shoulder. Good pain control is an important part of the postoperative management. Once the range of motion and strength goals are achieved the exercise program can be cut back to a minimal level. However, it is important to recognize that surgery cannot improve the basic quality of the tendon tissue. J Bone Joint Surg Am 82(6): 838-42. As a result, within three months after a rotator cuff repair, it is common for the dye to leak through the tendon since it has not completely healed. If a return to athletics is desired, sport-specific exercises for throwing may also be introduced during this stage. Oluseun Olufade, MD, is a board-certified orthopedist. Your shoulder is made up of three bones: the upper arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle). It should be noted that some rotator cuff tears are not painful. This motion needs to be repeated with the arms in front of the body, both held out straight and in the flexed position. The reality is that some people can have good range of motion and function with torn rotator cuff tendons. In the second stage, you'll work on active stretching. Duckworth D. G. K. L. Smith et al. The superiority of these complex procedures to the "smooth and move" procedure has yet to be demonstrated. An experienced shoulder surgery team will use special techniques to minimize these risks but cannot eliminate them completely. The surgerys success is dependent on how well this interface between the tendon and bone heals. The shoulder should not be used with the elbow away from the side for 3 months after a rotator cuff repair. (2004). Rotator Cuff and Shoulder Conditioning Program, Rotator Cuff and Shoulder Rehabilitation Exercises. This early motion is facilitated by the complete surgical removal of the scar tissues so that after surgery the patient needs only to maintain the range of motion achieved at the operation. For full thickness tears that are moderate size (one to three centimeters), the re-tear rate is around 20% (Figure 8). Mack L. A. M. K. Gannon et al. "Open rotator cuff repair without acromioplasty." Similarly, RC pathology is seen across all ages. Clin Orthop Relat Res(390): 142-50. All scar tissue is removed from the space beneath the deltoid and the acromion (part of the shoulder blade to which the deltoid attaches). The chance that the tendons will heal with surgery is directly related to how large the tear in the tendons was before surgery. However after surgery scar tissue will tend to recur and limit movement unless motion is started immediately. understand the post-operative rehabilitation program. If you have a degenerative tear in one shoulder, there is a greater likelihood of a rotator cuff tear in the opposite shoulder even if you have no pain in that shoulder. This surgery typically requires four stages of physical therapy as you recover. However, even those patients with very large tendon tears may benefit from surgery. Multiple injections of steroids are discouraged for this reason. It will also get you back to your normal routine quicker. Pain medications can be very powerful and effective. This operation is helpful for only a minority of patients and has lost favor among shoulder surgeons [12]. This is called frozen shoulder. Neck arthritis with nerve impingement may cause shoulder pain and weakness that is worse when the head is held in certain positions. However, older, multiply injured, multiply injected tendons or tendons in a smoker may tear with no injury at all. To maximize the likelihood of successful rehabilitation, be sure to find a physical therapist who is skilled in treating patients who undergo rotator cuff repairs. Surgery for chronic cuff tears can be delayed until the time that is best for the patient's overall well-being. Surgery. Follow-up is the Monday after Thanksgiving. This type of tear is best described as a tear that occurs in a way analogous to "wearing a hole in the seat of one's pants"; the tendon just gets thinner and thinner over time until there is a hole there (called an "attritional tear"). "Sonographic evaluation of the rotator cuff. A licensed physical therapist can guide the patient on appropriate exercises. Rotator cuff surgery usually takes approximately one hour. Medications cannot help a torn tendon heal. MD see at Week 4 post-op and will usually be advanced to a more aggressive ROM and stamina program. X-rays confirm the presence of arthritis. After the healing it may take months of gentle exercises before the shoulder achieves maximal improvement. However it is possible for full or partial thickness tears to stabilize leaving the shoulder with reasonable comfort and function. Your doctor is likely to start with a combination of several treatments including: If those dont work, you may need surgery, especially if you have a complete tear. In the hands of an experienced sonographer, dynamic shoulder ultrasound is a quick safe and reliable method for documenting the status of the rotator cuff tendons. The combination of this smoothing with immediate, post-operative motion is known as the "smooth and move" procedure. Increase mobilizations of soft tissue as well as glenohumeral and scapulothoracic joints for ROM. Shoulder motion soon after rotator cuff surgery helps achieve best possible shoulder function. Once a tear is all the way through the tendon (called "full thickness"), the next issue to consider is the size of the hole in the tendon. Weakened degenerative cuff tissue is more easily torn even by normal activities. When performed by an experienced surgeon rotator cuff surgery usually leads to improved shoulder comfort and function. Even 6 months after the surgery, 38% of patients still experience sleep problems. Research Click an image below to enlarge and enter the photo gallery of rotator cuff pathology. Rotator cuff tears are more common in the dominant arm the arm you prefer to use for most tasks. "Repairs of the rotator cuff. We usually recommend that during the first three months the emphasis in physical therapy and with your home program should be on regaining motion in your fingers, wrist, elbow and shoulder. Do I Need Physical Therapy for a Rotator Cuff Tear? (1995). Some have advocated the repair of rotator cuff tears using shoulder arthroscopy. Generally, a patient wears a sling for the first two to three weeks and begins physical therapy one week after surgery. Infections may require a "wash out" in the operating room and subsequent antibiotic treatment. He loved it and it helped his recovery so much! Rotator cuff surgery is a highly technical procedure; each step plays a critical role in the outcome. That said, this stage of therapy typically lasts for two to eight weeks, depending on the size of the tear and your surgeons preferences. Rehabilitation following surgical repair of the rotator cuff: a systematic review. However, 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 tearing due to wear and tear over the years. A relatively new prosthesis called the reverse prosthesis has had some promise in patients with arthritis and torn rotator cuff tendons that are not repairable. Rotator cuff disease must be distinguished from shoulder arthritis, arthritis of the acromioclavicular joint, subacromial bursitis, frozen shoulder, and neck arthritis; each of which may produce similar symptoms. This method of attachment leaves a smooth upper edge of the cuff repair to glide beneath the acromion and deltoid and avoids possible problems with suture anchors. Stiffness in the shoulder can be the cause of pain months after the surgical repair, so it is important that stiffness be addressed even months or years after the surgery. Following a rotator cuff repair, the affected arm is usually placed in a sling by your care team. Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. Lift the weight until it is pointing toward the ceiling then lower it gradually. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Mack L. A. F. A. Matsen 3rd et al. What is the risk of waiting to have rotator cuff surgery? With the arms above the head, lean the ski pole as far as possible to the left and then to the right. This muscular group surrounds the head of the humerus (the ball-shaped top of the arm bone) and helps to elevate and rotate your shoulder. The first way to describe tears of the rotator cuff tendons is whether tears are part of the way through (called "partial thickness") or all the way through the tendon (called "full thickness". (2000). X-rays are taken to exclude other problems. 1997; 6(5):413 422, (2B), (E) 4.0 4.1 Oh JH, Yoon JP, Kim JY, Oh CH. You also may get exercises to do at home and suggestions that help you use your shoulder in safer, more comfortable ways in your day-to-day life. After three months these stretching exercises are continued and strengthening exercises are added (see movies 2-5). The rotator cuff is a common source of pain in the shoulder. Patients should avoid activities that involve major impact (chopping wood contact sports sports with major risk of falls) or heavy loads (lifting of heavy weights heavy resistance exercises). It takes the repaired rotator cuff tendons about six weeks to heal initially to the bone, three months to form a relatively strong attachment to the bone, and about six to nine months before the tendon is completely healed to the bone. Finally, you'll work on initial strengthening and eventually weight-bearing strengthening until you get back to normal levels of movement. Clicking may also occur with movement of the arm. In this technique dye is injected into the joint so that leaks through the cuff can be seen on X-rays. Smoking should be stopped a month before surgery and not resumed for at least three months afterwards--ideally never. Patients usually require some assistance with self-care activities of daily living shopping and driving for approximately three months after surgery. The exercises are not dangerous if they are performed gently so that they do not risk enlarging the cuff tear. Durable repair of these tears may not be possible because of the lack of sufficient quantity and quality of tendon tissue. Most people with rotator cuff problems can be successfully treated by a combination of exercises (avoiding overhead activities), painkillers, physiotherapy and occasionally steroid injections. Pain can be the result of: Tendinitis. We typically recommend physical therapy only twice a week. "Challenges in evaluating patients lost to follow-up in clinical studies of rotator cuff tears." X-rays to see if the top of your arm bone (humeral head) is pushing into your rotator cuff space. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010. Shoulder weakness after an acute injury or fall. When the rotator cuff tendons are injured or damaged, this bursa can also become inflamed and painful. After 3 months. Patients at Hospital for Special Surgery have this procedure done under a nerve block (regional anesthesia) and partial sedation rather than under general anesthesia. Clin Orthop Relat Res(234): 21-7. Untreated tears tend to get bigger, so it is best to repair tears while they are small. The acromioclavicular (AC) joint is located between the acromion (part of the scapula that forms the highest point of the shoulder) and the clavicle. Rehab after rotator cuff surgery helps recovery. (2000). The subscapularis is the anterior stabilizer of the rotator cuff and responsible for internally rotating the shoulder. By reflecting sound waves off the tendons ,sonographic images are created as the tendons move. So what do I do if a rotator cuff tear fails. 1959 N.E. A. Sidles et al. Patients are almost always satisfied with the increases in range of motion comfort and function that they achieve with the exercise program. How do you select a doctor for rotator cuff surgery? Rotator cuff repair surgery involves fixing torn or damaged tendons in the shoulder. Those who have a cuff tear in one shoulder are likely to have similar problems in the opposite shoulder. Again achieving this smooth movement may require trimming of the tendon edges or the bone of the upper humerus. "Sonography of the postoperative shoulder." Radiol Clin North Am 26(1): 161-77. Severe separations in an upward direction or dislocations in the backward or downward directions often require surgery. The rotator cuff is a set of a four small muscles in the shoulder that allow the upper arm to rotate. However, the small percentage of patients whose symptoms have not improved after 6 months of dedicated physical therapy may be candidates for surgery. The goal of any treatment is to reduce pain and restore function. Arthritis of the acromioclavicular joint usually produces pain localized to the top front of the shoulder that is made worse by using the arm in front of the body. Improvement in some activities may be evident as early as three months. One of the major goals of rotator cuff surgery is to relieve any stiffness. For severe, massive tears, a complete recovery can take anywhere from 6 to 12 months. If you have a degenerative tear in one shoulder, there is a greater likelihood of a rotator cuff tear in the opposite shoulder even if you have no pain in that shoulder. Chronic shoulder and arm pain are good reasons to see your doctor. The doctors can prescribe therapy based on the work done during the operation. Why am I still having symptoms after rotator cuff surgery? Commonly they have difficulty sleeping on the affected shoulder and have a limited range of active motion. Patients should notify their surgeon if they have had previous difficulties with pain medication or pain control. Associate Attending Orthopedic Surgeon, NewYork-Presbyterian Hospital. When riding, try to achieve the maximum degree of bending and straightening possible. Phase 1:Passive motion: 1-6 weeks depending upon the size of tear and strength of the repair. When a rotator cuff is torn, the tendon part of the muscle tears away from the bone of the upper arm. A rotator cuff tear is an injury where one or more of the tendons or muscles of the rotator cuff of the shoulder get torn. In a shoulder arthroscopy, small incisions are made and an arthroscope a small tube fixed with a camera is navigated to the site of the tear. If the cuff is repaired it takes months before the tendon is strongly healed to the bone. Episode 181: Athletes Undergoing Concomitant Hip Arthroscopy and Periacetabular Osteotomy Demonstrate Greater Than 80% Return-to-Sport Rate at 2-Year Minimum Follow-Up Professional athletes and manual laborers are often treated with surgery, but the results are often unpredictable. It is also possible to tear more than one tendon completely. Mack L. A. D. A. Nyberg et al. This early motion is facilitated by the complete surgical removal of the scar tissue so that after surgery the patient needs only to maintain the range of motion achieved at the operation. The reasoning behind extending and reinforcing the irritated rotator cuff in order to speed healing and practical efficiency is as follows: The irritated tissue is defined by increased fluid in between the cells, increased varieties of new members vessels, and inflammatory type cells. Rotator cuff surgery may be performed under a general anesthetic or a brachial plexus nerve block. If good quality tendon will not reach its attachment site after these releases the cuff tear is deemed to be irreparable. However the preoperative preparation and the postoperative recovery may add several hours to this time. 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 time for healing; on the other hand, if the tear is small, they may allow a little more motion earlier than usual after the surgery. Physical Therapy for Rotator Cuff Impingement: What to Expect, Shoulder Pain: Types, Diagnosis and Treatments, Shoulder Arthroscopy Types and Complications, Causes of Shoulder Pain and Treatment Options. Because most rotator cuff tears are largely caused by the normal wear and tear that goes along with aging, people over 40 are at greater risk. Conditions of the rotator cuff are the most common cause of problems of the shoulder. Clin Diagn Ultrasound 30: 113-33. The duration of this phase can vary widely depending on the extent of the surgery and your pre-existing strength, but generally, it lasts between two and three months. Your arm is kept in your shoulder socket by the rotator cuff. Sometimes the pain and stiffness from rotator cuff disease will stabilize at a level that is acceptable to the patient. By Tim Petrie, DPT, OCS The pluses and minuses of these procedures should be discussed with your physician. 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