Surgery for Shoulder Tears

If a shoulder tear causes consistent, severe pain and limits your ability to participate in daily activities, NYU Langone orthopedic surgeons offer procedures to fix a torn tendon or labrum and restore shoulder function.

The decision to have surgery is based on how much your symptoms affect your quality of life. Surgeons may see a large shoulder tear on an MRI scan, but if the injury is not causing significant pain or dysfunction, surgery is probably not necessary. Alternatively, a tear that causes chronic pain or weakness in the arm may warrant surgery.

Arthroscopic Surgery

For most people who need surgery for a tear in the rotator cuff, a biceps tendon, or the labrum, NYU Langone doctors recommend arthroscopic surgery. This minimally invasive procedure allows the surgeon to access the shoulder using very small incisions, reducing damage to surrounding muscle and ligaments, and making recovery faster and easier.

A surgeon performs arthroscopic surgery using a slim instrument called an arthroscope, which has a video camera and a light at one end. When the surgeon inserts the arthroscope into the shoulder through a small incision, it sends a video feed to a nearby monitor. This gives the surgeon a clear view of the interior of the joint and shows tiny details in the tendons and labrum.

Next, the surgeon inserts small surgical tools into the shoulder through a separate small incision. With the video feed provided by the arthroscope as a guide, he or she uses these tools to correctly position a torn tendon or labrum and reattach it to the bone.

During arthroscopy, the doctor may find rough protrusions called bone spurs on the acromion, a bony projection at the top of the shoulder blade that forms part of the shoulder joint. If so, he or she may use a small tool to shave them down. Bone spurs may interfere with the smooth, gliding motion of the joint and cause tendons to tear.

General anesthesia is typically required for people having arthroscopic surgery for a shoulder tear. Doctors also often use a nerve block, an injection that temporarily prevents nerve signals from reaching the shoulder. This provides 10 to 12 hours of pain relief after surgery.

What to Expect After Arthroscopic Surgery

At NYU Langone, arthroscopic surgery is an outpatient procedure, so you can expect to return home within hours of surgery. Doctors may prescribe pain medication for the first week or two so you can heal comfortably. As your shoulder heals, pain decreases. Doctors recommend transitioning to an over-the-counter pain medication, such as ibuprofen, to relieve any further discomfort.

Doctors typically recommend wearing an arm sling for four to six weeks to keep the shoulder immobile. They schedule a follow-up appointment for one week after surgery to monitor your healing.

After you have healed, doctors recommend physical therapy to rebuild muscle strength and restore range of motion. How long recovery takes depends on the size and type of shoulder tear. Your surgeon and physical therapist work with you to create an individualized plan.

Reverse Total Shoulder Replacement Surgery

Sometimes, a severe rotator cuff tear leads to degeneration of the shoulder joint and requires joint replacement surgery. During this procedure, damaged areas of the shoulder joint are replaced with durable prosthetic, or artificial, parts.

This is an open surgical procedure, meaning that surgeons access the joint through a single incision made above the shoulder joint, instead of several small incisions.

Usually, joint replacement is an option for people who have multiple tears that have affected the shoulder over a long period of time. It may also be recommended for people who have symptoms such as partial paralysis of the arm and chronic pain.

For people with severe rotator cuff injuries, doctors may recommend a procedure called a reverse total shoulder replacement. This type of surgery restores function in the shoulder by reversing the natural anatomy of the joint. Instead of replacing the shoulder’s ball-and-socket components with matching prosthetic parts, surgeons switch their positions and implant a metal “ball” in the shoulder blade and a plastic “socket” into the top part of the arm bone, or humerus.

After this surgery, the new shoulder joint no longer uses muscles in the rotator cuff and instead relies on other nearby muscles, called deltoid muscles, to function. This restores a natural range of motion.

A surgeon performs reverse total shoulder joint replacement using general anesthesia.

What to Expect After Reverse Total Shoulder Replacement Surgery

After surgery, you should expect to spend about two nights in the hospital, where NYU Langone nurses and pain management specialists are available around the clock to ensure that you have the pain relief medication you need to recover comfortably.

A physical therapist visits you the day after surgery to help you gently start to use your shoulder. Our doctors encourage you to start physical therapy as soon as possible to build strength around the joint and expand range of motion.

Physical therapists at NYU Langone’s Rusk Rehabilitation and NYU Langone Orthopedic Center are specially trained to assist people with shoulder replacements. They can show you simple exercises to perform while you are still in the hospital and after you go home.

When you return home, your arm stays in a loose sling for four to six weeks to give your shoulder a chance to heal without bearing weight. The sling can be removed when you eat and sleep. Your surgeon schedules a follow-up visit 8 to 10 days after surgery to make sure the joint is healing properly.

Physical therapy continues for about 12 weeks, either at Rusk Rehabilitation or at a location near your home. During the first six weeks, physical therapists help you restore your full range of motion using stretching and other exercises that improve flexibility. Then, over the next four to eight weeks, therapists help you strengthen and tone the muscles in your shoulder, arm, and upper back. Improving the strength and flexibility of these muscles provides your shoulder with long-term support and stability.

Many prosthetic joints last for years without wearing out or causing complications. But sometimes a prosthetic joint becomes unstable. If you’ve had a joint replacement, your surgeon may schedule annual appointments to monitor the implanted joint and, if necessary, explore options to repair or replace aging parts.

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