The rotator cuff is a complex structure within the shoulder joint composed of a number of muscles and tendons. The muscle-tendon units provide rotation and strength to the shoulder so it can move in a stable, coordinated manner. The tendons of the rotator cuff can become damaged from repetitive shoulder rotation, a sports injury, a fall, or degeneration from the natural aging process. When one of these tendons becomes torn from its attachment site, a surgical rotator cuff repair is required to return full function to the joint. Unfortunately, not all of these repairs correct the damage and alleviate shoulder symptoms. Certain patients may even re-tear or re-injure the tendon, necessitating revision rotator cuff repair. Dr. Matthew Provencher, Vail, Aspen and Denver, Colorado orthopedic shoulder surgeon, is highly experienced in revision shoulder surgery designed to correct recurrent tears of the rotator cuff.
A partial or complete tear of a rotator cuff tendon typically requires shoulder surgery to repair the damaged area. An arthroscopic approach is typically performed by Dr. Provencher, if possible, so patients can experience less pain following surgery and a quicker recovery time.
In certain cases, the initial treatment may not have been performed correctly, the original rotator cuff injury was misdiagnosed, or the original procedure left residual symptoms. Patients may even re-tear or re-injure the rotator cuff from a fall, returning to activities too quickly, failure of the tendon to heal back to the bone, or chronic shoulder overuse. When a re-tear occurs, Dr. Provencher generally recommends a revision rotator cuff repair to provide the patient with normal joint function.
A revision shoulder surgery to the rotator cuff is a more difficult procedure mainly because a repair has already been performed, the tendon has proven in multiple instances to be particularly prone to tearing, and often the first intervention results in extensive scar tissue formation.
Dr. Provencher performs an arthroscopic revision rotator cuff repair in many cases. He strives to make to identify the healthy tendon and to reattach it to its original anatomical attachment site in a minimally invasive procedure.
An arthroscopic suprascapular nerve release is reserved for patients where a re-tear of a rotator cuff tendon places pressure on the suprascapular nerve, leading to pain and changes within the muscle.
Large re-tears that occur at the junction of the tendon and muscle may not be able to be fully repaired by Dr. Provencher. Large re-tears are less common and may need to be repaired with a different shoulder surgery technique, such as debridement or augmentation.
Recovery and Rehabilitation Following Revision Rotator Cuff Repair Surgery
Following revision shoulder surgery, the repaired shoulder will be placed in a sling to immobilize the joint and to protect the repairs for approximately 6-8 weeks. A physical therapy program will be prescribed by Dr. Provencher and will begin immediately following the procedure. It is strongly suggested that patients work with the in-house physical therapists at Howard Head Sports Medicine to optimize their rehabilitation. Physical therapy progression varies for each patient and depends on type of revision rotator cuff repair performed, patient’s age, and patient’s overall health.
For additional resources on revision rotator cuff repair, or to determine if you are a candidate for this shoulder surgery, please contact the Vail, Aspen and Denver, Colorado orthopedic office of Dr. Matthew Provencher.