Q: I'm 66-years-old and participating in the Senior Olympics for the first time. Right out of the shoot, I tore my rotator cuff (the subscapularis muscle). What would you predict for recovery time?

A: The largest muscle in the rotator cuff is the subscapularis. This muscle helps rotate the shoulder and arm inward (internal rotation). The subscapularis helps stabilize the shoulder in the socket and prevent forceful anterior (forward) dislocations.

The subscapularis also helps balance the force applied on the shoulder from the posterior (back side of the) rotator cuff. The rotator cuff surrounds the entire shoulder joint like an envelope (front, back, side, and under the arm). Any weakness on one side from a tear or damage to the rotator cuff will affect how the rest of the cuff functions.

Surgery to repair the rotator cuff can be done with a traditional open incision procedure or with a more minimally invasive approach using arthroscopy. Arthroscopic surgery involves the use of a surgical scope that is inserted into the joint. It gives the surgeon a view inside the joint in order to identify the torn parts and fix them.

Surgical techniques used differ depending on the location and severity of tendon tear/rupture. Type of sport the athlete is involved in is also considered when planning the specific surgical approach. Attention is paid both to functional demand and cosmetic appearance.

Your post-operative recovery and return-to-sports will depend somewhat on how invasive the surgery is, how severe the damage is, and your overall health and condition before the injury. Patients with good strength, good health, and a good attitude often have the best results.

You may be placed in a shoulder splint for 10 days up to three weeks. Again, this depends on the extent of the surgery, surgical technique used, and surgeon preference. Most surgeons performing a rotator cuff tendon repair will tell the patient there's to be no lifting and no vigorous activity. These restrictions often last six weeks up to 12 weeks.

A rehab program under the direction of a physical therapist is often advised. The physiotherapist will guide you through the prescribed exercises and gradually progress you through activities. Sports specific training for athletes helps them return to their chosen sports fit and ready for the challenges they face. You may expect the process from surgery through rehab to last about six months (longer if there are complications).

Reference: Christoph Bartl, MD, et al. Open Repair of Isolated Traumatic Subscapularis Tendon Tears. In American Journal of Sports Medicine. March 2011. Vol. 39. No. 3. Pp. 490-496.