You are considering rotator cuff surgery. You are concerned about your rotator cuff healing and recovery. Many rotator cuff tears will heal after surgery. Some tears, however, may not heal. Rotator cuff healing is a very complex topic. Why? Because the rotator cuff is a very complex structure, and the shoulder is a tough environment for healing to occur. Healing of your rotator cuff tear will be dependent on many different variables. This post will cover healing of your rotator cuff tear. We will discuss the relevant information we use to determine if your tear has a good chance of healing after rotator cuff surgery.
Many of you will develop a rotator cuff tear due to severe tendinosis (degeneration) of your rotator cuff. That is simply because the rotator cuff tendon can wear out over time. Although far less common, some of you will tear your rotator cuff after a fall or injury.
Healing of your rotator cuff
Healing of your rotator cuff tear will depend on many issues, including:
- the cause of your rotator cuff tear (degeneration versus injury)
- the size of your tear and
- how long your tear has been present.
Many of you have already tried injections, anti-inflammatories , an ice compression wrap and physical therapy. For some of you that worked, for others a rotator cuff repair surgery becomes an option. Let’s review the current research about rotator cuff healing.
The rotator cuff are a group of four muscles that surround the shoulder. They come together in a “cuff” which surrounds the top of your humerus. The rotator cuff of a 50 year old does not look like the rotator cuff of a 20 something. Think of your favorite pair of blue jeans — the denim around the knee looks very different then it did when your purchased them 15 years ago. The rotator cuff can wear out too. If it wears out enough, a tear or defect can result.
There is a lot of information on the web about rotator cuff tears… the more you read, the more confused you might be. Some evidence based facts you might find helpful:
- Do all rotator cuff tears require surgery? No.
- Can the rotator cuff tear become larger without surgery? Yes.
- Can the rotator cuff heal without surgery? No.
- Do all rotator cuff tears heal? Short answer, No.
There is also a lot of controversy about what we as surgeons should do both during and after surgery to try and give your rotator cuff tear a better chance at healing. Below are a set of observations recently published in one of our major journals. They are meant to show whether or not many of the tips/tricks we try at the time of your rotator cuff surgery will improve the chance of healing.
What might affect rotator cuff healing
➤ Several studies have noted that increasing age is a significant risk factor for diminished rotator cuff healing. This may be because our rotator cuff tissue is wearing out. Biomechanical studies have suggested the reason for this may be an inferior healing environment in older patients. Healing is complex. It takes many cells, and chemicals or proteins to help heal a tendon. As we age, the chance creating a healing environment in the shoulder diminishes.
➤ Larger tears and fatty infiltration or atrophy negatively affect rotator cuff healing. This post will explain why the size of the rotator cuff tear matters.
➤ Arthroscopic rotator cuff repair, removing bone spurs in the shoulder, and the use of platelet-rich plasma (PRP) do not demonstrate an improvement in structural healing over mini-open rotator cuff repairs, single-row repairs, not performing an acromioplasty( removing a bone spur), or not using PRP. (Despite evidence that bone spurs do not cause tears, or improve healing of tears if they are removed, many surgeons will recommend it)
➤ There is conflicting evidence to support postoperative rehabilitation protocols using early motion over immobilization following rotator cuff repair.
via The Journal of Bone & Joint Surgery | Factors Affecting Rotator Cuff Healing.
So… what does that mean to you ?
Rotator Cuff Healing Take Home Messages
– IF you are over 60, your rotator cuff tissue is wearing out. While we have very strong sutures and very strong ways to attach your rotator cuff to the bone… that does NOT address the underlying reason why your rotator cuff might not heal. Your rotator cuff repair might fail because your tissue is simply too worn out. Again.. imagine closing a big hole in the front of your jeans. The strength of the thread doesn’t matter , because the fabric is soft, and falling apart. Only recently have shoulder surgeons started to use a biological patch to try an reverse the degenerative changes in the tissue. If all goes well, this patch could theoretically decrease the risk of re-tearing your rotator cuff. Ask your surgeon if they plan on using this. Many orthopedic companies are now starting to offer various type of patches. These patches might increase the chance that a rotator cuff will heal. Time will tell as the research into this are continues.
We in the in Orthopedic community need to change our focus to the “biology” of healing. For far too long we focused on using stronger sutures, or stronger bone anchors. Instead, we now need to focus on technologies that could reverse the tendinosis or degeneration and improve the healing environment within your shoulder.
– A bone spur in your shoulder is NOT the reason why you should consider surgery. There have been so many research studies showing that removal of the bone spur does not improve shoulder pain or decrease the risk of developing a new rotator cuff tear.
– Large tears do not heal as well as smaller tears. Some small tears will become larger with time. Sometimes it’s best to consider surgery sooner rather than later to improve your chance that the rotator cuff will heal.
Perhaps THE MOST important paper to come out in the realm of rotator cuff repairs showed that your risk of your rotator cuff tear not healing or tearing again extends beyond 6 months after surgery. These researchers showed that if your therapy is too aggressive or if you return to your normal activities too fast your rotator cuff repair might fail. That would be a shame to put in all that effort and endure all the pain only to have your rotator cuff repair fail. If your PT or surgeon says you can return to normal activities before 6 months they’re simply wrong. Protect that shoulder of yours, your first repair is your best chance at a successful rotator cuff repair.
I hope this little lesson in rotator cuff healing was helpful. If you still have other questions about rotator cuff tears there are many, many more posts on this site to guide you.
Click HERE to learn 5 more key facts about rotator cuff tears.
Further updated thoughts on why a rotator cuff tear might not heal can be found here.
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sherry
I would like to know is it possible to return to work 2 weeks after rotator cuff surgery??I am a teacher so I don’t have a physical job that would require intense range of motion on my arm…..but I can’t afford to be out of work several weeks ……
Howard J. Luks, MD
I personally allow you to return to work as long as you can wear your sling…
BUT…
Driving is an issue, and you can not be on pain medications.
I would review this with your surgeon to get their personal thoughts.
Bobbie Tilley
Dear Dr. Lula,
Hi I have a question. I’m a 39yr old female. About 5years ago I had an mri done which showed a rotator cuff tear. Nothing was ever done about it. Today I’m having so much pain it hurts to take a deep breath,mo e my head/neck, & or any movement of my right arm/shoulder. I’m in tearS even after taking g heavy pain meds that I take for my fused back. What needs to be done? Please help me this is such a horrible pain.
Thanks so much Dr. Lula
Howard J. Luks, MD
You need to see a good shoulder and or neck doctor
Gina
I have been diagnosed with partial tear rotary cuff…pain not bad and doing strength exercises as prescribed by dr. I am a swimmer… Could this have caused it…I haven’t swam since and am afraid to… Will it cause further damage or improvement…will the tear become bigger..,I am confused please advise
JW
Dr.H Lucas, Four weeks ago while sparring, I threw a wide/high left hook and missed. Felt something in my shoulder toward the back, can’t explain it because adrenaline. I have been taking it extremely easy since then; no lifting or training. It only hurts if I lay in bed at night with a baseball pitchers arm motion(Owens test) and it is a dull pain or hanging my arm out of the window of my car and still dull pain. I tried the labrum/rotator cuff tests which are shown by Dr’s on youtube but obviously unsuccessful. Wanting to get back should I wait another week or make an appointment? Have weak insurance where I live so any information given is extremely appreciated. Thank you very much for your time, Jw
Howard J. Luks, MD
JW .. There’s little harm in waiting another week or two and trying to stretch it out and do some light resistive work. No sparring, etc. If you do not notice improvement then I would see an sports doc
Lou
Hi Dr. Luks,
On 2/17/15, my surgeon performed arthroscopic surgery of the right shoulder for a full thickness supraspinatus tear. I was in a sling for 6 weeks and attended PT 3x/week for 17 weeks. The last followup with the surgeon was very encouraging. I have almost complete ROM with some good strength building up. Yesterday, 6/26/15, I took a small, patio level dive in the pool and in the middle of completing my initial underwater stroke, I felt a sudden stretching pain in the repair area that frightened me. I woke up this morning with some stiffness and feel some light to moderate pain in certain arm positions (sometimes even just leaning over). It’s difficult to describe the sensation, but I would say it’s sort of like a tangle of tendons/muscles that dissipates as I engage the area. I’ve been extremely paranoid about re-injuring the tendon and as such I’ve been very cautious with it. The dive was calculated and controlled (which I’ve done several times in the past 2 weeks with no issues). I’m so fearful that I may have torn it again. I realize you can’t provide a diagnosis. But I’d love to know what “normal sensations” at this stage of my recovery I should expect? Before the incident, I felt practically no pain/discomfort. Since the incident, it’s sort of sore and stiff.
Thanks for your time!
Howard J. Luks, MD
There are many “normal” sensations after a rotator cuff repair. But keep in mind that up to 40-50% of rotator cuff repairs actually fail — which means the tendon doesn’t heal — BUT BUT BUT, the patient still feels fine. It sounds unusual but it is true. You do not need a fully repaired cuff to be comfortable. Anyway… continue with your activities… stretch, warm up and nothing quick or abrupt. The risk of re-injury is highest 20-24 weeks after surgery. Read Ianotti’s paper out of the Cleveland Clinic. If your pain and discomort persist after another few weeks then check in with your doctor. http://jbjs.org/content/95/11/965