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Texas sports medicine and orthopaedic group

RICHARD S. LEVY, M.D.photo of Dr. Levy

ASSISTANT CLINICAL PROFESSOR, University of Texas Southwestern Medical Center
DIPLOMATE, American Board of Orthopaedic Surgery
FELLOW, American Academy of Orthopaedic Surgeons
DESIGNATED DOCTOR, Texas Division of Workers' Compensation

A torn rotator cuff is a common cause of shoulder pain. Rotator cuff repair is surgery that repairs a torn tendon (rotator cuff tear) in the shoulder (tendons connect muscle to bone). The rotator cuff is a grouping of muscles and tendons that form a “cuff” over the shoulder, keeping the arm in the ball-and-socket joint and helping the shoulder to rotate. The name of the tendon in the shoulder is the “rotator cuff tendon.” Rotator cuff tendon injuries most commonly occur due to the wear and tear associated with aging. Often, what appears as a minor injury causes the tendon to give way. On occasion, a single injury will cause the problem. Dr. Levy may recommend rotator cuff repair if you experience shoulder pain when using your arm in positions over your head, weakness in the arm and a bone spur or inflammation around the rotator cuff and if you have failed conservative management. There are other options available, including no treatment, physical therapy exercises or pain medication, and sometimes, injections. In the majority of cases, tendon repair is possible. About five percent of the time, this is not possible. In this situation, the removal of inflammation, scar tissue and bone spurs often helps to diminish the shoulder pain but overhead use usually does not return to normal. Rarely, the condition can improve without surgery. Most often, the pain increases and the movement and strength decrease. Fortunately, this usually occurs slowly over the years.

The Surgery
During shoulder arthroscopy, a small camera, called an arthroscope, is inserted near the shoulder joint through a small (usually one-quarter inch) incision. The arthroscope is attached to a video monitor to allow Dr. Levy to look inside your joint. Instead of making a large incision, Dr. Levy uses three small incisions. Through one incision, he inserts the arthroscope to look inside your shoulder. He inserts special instruments that allow the removal of scar tissue and bone through the other two incisions. Dr. Levy will then insert sutures and/or anchors with sutures into the shoulder. We use special instruments to weave the sutures through the torn tendon.


Rotator Cuff Tear
The rotator cuff muscles and their tendons.   A typical location for a rotator cuff tendon tear.
Suture Placement
Finished Repair
The sutures are placed through the bone. The green and white sutures are ready for the repair.   The sutures have been placed through the torn tendon. The sutures hold the tendon in position while it heals to the bone.

Following your surgery, you will use a machine called a Continuous Passive Motion (CPM) chair to move your arm in the correct planes. You will use this at home for four weeks after the operation. (Delivery and pickup will be arranged). Patients use the chair to maintain range of motion. Use the ice pack for one hour after each chair session. You will be examined four to six weeks after surgery to determine when you should start formal rehabilitation. You will use the sling and cannot actively raise your arm up or away from your side until Dr. Levy advises you to. At the three-month visit, you usually begin strengthening exercises.
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