Understanding Rotator Cuff Repair (Open / Subscapularis)
If you’ve experienced persistent shoulder pain, weakness, or difficulty with certain arm movements, especially after a sudden injury or from long-term wear and tear, you might have a torn rotator cuff. If the tear is significant, particularly involving the subscapularis tendon, your doctor might recommend an Open Rotator Cuff Repair. This surgery aims to reattach the torn tendon(s) back to the bone to restore strength and function to your shoulder, sometimes requiring a more traditional approach.
What’s Going On with Your Rotator Cuff and Subscapularis?
Your rotator cuff is a group of four muscles and their tendons that surround your shoulder joint. They act like a “cuff” to help lift and rotate your arm, and crucially, to keep the “ball” of your upper arm bone (humerus) stable within the shallow “socket” of your shoulder blade.
One of these four key tendons is the subscapularis tendon. This tendon is located on the front of your shoulder blade, underneath your other shoulder muscles, and it attaches to the front of your upper arm bone. The subscapularis muscle is very important for:
- Internal Rotation: Rotating your arm inward (like reaching behind your back).
- Adduction: Bringing your arm down towards your body.
- Front Stability: Helping to keep the shoulder stable, especially when the arm is lifted overhead.
A rotator cuff tear, especially one involving the subscapularis, occurs when one or more of these tendons pull away from the bone. This can happen due to:
- Acute injury: Often from a fall, sudden forceful lift, or a traumatic dislocation of the shoulder.
- Degeneration (wear and tear): Although less common for the subscapularis than other rotator cuff tendons, it can also degenerate over time.
When the subscapularis tendon tears, you’ll typically experience pain (often in the front of the shoulder), significant weakness when trying to rotate your arm inward or lift it forward, and difficulty with activities that require reaching across your body or behind your back.
How Does Rotator Cuff Repair (Open / Subscapularis) Help?
An Open Rotator Cuff Repair is a surgical procedure designed to reattach the torn rotator cuff tendon(s), particularly the subscapularis, back to the humerus bone. The goal is to restore the normal connection, allowing the tendon to heal and improving the strength and stability of your shoulder.
The term “open” means the surgeon makes a single, larger incision (cut) near the shoulder to directly view and access the torn tendon. This approach is often chosen for:
- Larger, more complex tears: Where extensive repair or better visibility is needed.
- Specific tears: Such as a subscapularis tear, which may sometimes be more easily accessed and repaired through an open approach.
- Revision surgeries: If a previous repair was not successful.
During the surgery, the surgeon will:
- Access the Tendon: An incision is made on the front of your shoulder, sometimes requiring temporary detachment of a shoulder muscle to gain full access to the subscapularis tendon.
- Prepare the Tendon and Bone: The torn edges of the tendon are cleaned, and the area on the humerus bone where the tendon tore away is prepared to encourage healing.
- Reattach the Tendon: The torn tendon(s) are then firmly sewn back down to the bone. This is typically done using strong sutures, often secured with small anchors (which may be dissolvable or permanent) drilled into the bone.
Life After Rotator Cuff Repair (Open / Subscapularis)
After your open rotator cuff repair, physical therapy is absolutely essential for a successful recovery and to regain the full strength and function of your shoulder. This rehabilitation process is often lengthy and requires significant patience and dedication. Your physical therapist will guide you through a structured and progressive program, which typically includes:
- Protecting the Repair: Initially, your arm will be immobilized in a sling for several weeks to protect the newly repaired tendon and allow it to heal firmly to the bone. Strict limitations on movement, especially those that stress the subscapularis (like external rotation), will be in place.
- Gradual Movement Restoration: Once your surgeon clears you, you’ll begin very gentle, controlled exercises to slowly regain the range of motion in your shoulder, often starting with passive movements (where the therapist moves your arm) and gradually progressing to active movements. This is crucial to prevent stiffness.
- Progressive Strengthening: Your therapist will introduce strengthening exercises for your rotator cuff, shoulder blade muscles, and deltoid, as your tendon heals. This is vital for rebuilding power and stability for daily activities and sports.
- Functional Return: As you progress, your therapist will help you gradually return to your daily activities, work tasks, and sports, focusing on proper body mechanics and a safe, gradual progression back to full function.
Recovery from rotator cuff repair is a significant process that requires patience and dedication, often taking 6 months to a year or more for a full return to demanding activities. Following your physical therapist’s instructions closely is crucial for achieving the best possible outcome and safely returning to your desired activities with a strong, pain-free shoulder.