Understanding Rotator Cuff Surgery Scars

Rotator cuff injuries are a common cause of shoulder pain and impaired movement. The rotator cuff is made up of four muscles and tendons that surround the shoulder joint, providing stability and mobility. However, overuse or traumatic injury can cause tearing of these rotator cuff muscles and tendons.

When conservative treatments like rest, ice, physical therapy, and medication fail to resolve a rotator cuff tear, surgery may be necessary. The purpose of rotator cuff surgery is to reattach and repair torn tendons to relieve pain and improve function of the shoulder.

Surgical Procedures

Several types of surgery can be performed to treat rotator cuff tears. Common techniques include:

Arthroscopic rotator cuff repair: The torn tendon is reattached using small incisions and special instruments inserted through the incisions with a camera to visualize the joint.
Mini-open rotator cuff repair: A combination of arthroscopy and open surgery using a small incision splitting specific shoulder muscles to access and reattach the torn tendon.
Open rotator cuff repair: One larger open incision is made to fully visualize the torn rotator cuff muscle and directly repair it.

Resulting Scars

As with any surgery, rotator cuff procedures will leave behind a scar. However, the scar size, shape, position, and appearance will depend on the exact surgical technique used by your surgeon.

Arthroscopic Rotator Cuff Surgery Scars

Arthroscopic rotator cuff repair is a minimally invasive procedure that involves small incisions rather than large, open incisions. During the surgery, miniature cameras and special repair instruments are inserted through these tiny incisions around the shoulder.

There are typically three small shoulder scars from arthroscopic rotator cuff surgery, though some surgeons may use only two portals:

Posterior portal: Located on the back of the shoulder, this incision allows insertion of the arthroscope (camera).
Lateral portal: Allows insertion of repair instruments to fix the torn tendon. This scar is typically further back, near the shoulder blade.
Anterior portal: Some surgeons create this additional front incision to enhance visualization or access to the joint.

Appearance of Arthroscopic Scars

The portals used for arthroscopic surgery leave very small scars, usually less than 1 cm long. These scars will:

Vary slightly in size depending on instruments used
Initially appear pink or red
Gradually fade over one year
Usually heal into thin white line scars

Proper scar care can optimize healing and minimize long-term visibility of the surgical sites.

Open and Mini-Open Rotator Cuff Surgery Scars

In contrast to all-arthroscopic approaches, open rotator cuff repair techniques involve larger incisions to fully view and access the damaged tendons. This open exposure allows the surgeon to completely visualize, mobilize, and repair large or complex tears.

Mini-Open Rotator Cuff Repair Scars

The mini-open, or mini-incision, technique uses a combination of arthroscopic visualization plus a small open incision to repair the tendon. The scar from a mini rotator cuff procedure is larger than the small arthroscopic portals but smaller than a full open incision.

The mini-open scar is typically 3-5 cm long. It is positioned over the top of the shoulder, splitting specific shoulder muscles to optimize access to the rotator cuff tendons underneath. The scar appearance, healing, and care are similar to those of full open repair.

Open Rotator Cuff Repair Scars

During open surgery, the surgeon accesses the joint fully through one long incision over the top of the shoulder. This vertical scar generally measures between 5-10 cm long, extending over the deltoid shoulder muscle.

The appearance, maturation, and care of open rotator cuff scars follow the expected progression of postsurgical healing:

Pink or red initially
Darkens before gradually fading
Flattens and smooths over months
Fades to thin white line after 1+ years

The scar may remain mildly visible compared to surrounding skin depending on your healing tendencies and scar care.

What to Expect During Scar Healing

It is completely normal for new surgical scars to go through an evolution of appearance and sensation during the year after rotator cuff surgery. Typical experiences include:

Color changes: Redness, darkening, gradual lightening
Textural changes: Initial rawness smoothing out
Itching as part of natural wound healing
Numbness: Loss of sensation near scar
Sensitivity to sun due to lack of pigmentation

Your surgeon can advise you on appropriate scar care products and practices to help ensure proper healing and minimize long-term visibility.

When to See Your Doctor

Consult your surgeon promptly if you notice signs of poor wound healing or possible infection, including:

Ongoing drainage, bleeding
Expanding redness
Worsening pain
Fever

Significant trauma or overly aggressive activity can also disrupt scar healing. Follow all restrictions provided by your surgeon. Notify them about any injury near your shoulder scars.

Caring For Your Rotator Cuff Surgery Scars

Proper scar care techniques and practices can promote healing and optimize appearance of your postoperative shoulder scars. Considerations include:

Sun Protection

Incision sites from rotator cuff surgery often remain sensitive to UV rays for up to a year. Sun exposure can irritate scars and cause permanent darkening. Use sunscreen and protective clothing.

Massage

Gentle rotator cuff scar massage helps break up thickened tissue and desensitize nerve endings. Consult your surgeon for direction on appropriate scar massage techniques and timing.

Silicone Products

Silicone gels, sheets, and bandages can hydrate, soften, flatten, and lighten healing surgical scars after the incisions fully close. These products are supported by research for scar improvement.

Moisturize

Keep your postoperative shoulder scars moisturized but not soaked to optimize maturation and appearance. Topical scar creams allow deep hydration without surface moisture.

No Re-Injury

Avoid lifting, sudden movements, and sports that could re-damage healing rotator cuff tendons and scars. Adhere to any restrictions in motion or activity set by your surgeon.

By understanding the appearance, care, and appropriate treatment for your shoulder surgery scars, you can promote proper healing and long-term outcomes.

FAQs

How long will my rotator cuff surgery scars be red or dark?

It is normal for new surgical incision sites to appear pink, red, or slightly darkened for the first 6 to 12 months following rotator cuff repair. Over the first year, the scars will gradually fade and lighten to thin white lines.

Do rotator cuff surgery scars spread or widen over time?

No, it is very rare for appropriately closed and healed surgical incisions to later open up or expand in size. Rotator cuff surgery scars may thicken temporarily but should stabilize as slender line scars along the original incision path.

When can I use bio-oil or scar treatment after rotator cuff surgery?

Most surgeons recommend waiting until about 2-3 weeks after surgery before applying scar oils, gels, or other topical treatments. This allows time for complete wound closure to avoid irritation or contamination. Silicone sheets and other scar therapies are very useful starting at 1 month post-op.

Will my arthroscopic shoulder surgery scars be visible?

The tiny incisions used for arthroscopic rotator cuff repair generally heal into faint line scars that smoothly blend with the surrounding shoulder skin. While still mildly visible on close inspection, these tiny portals scars practically disappear compared to the shoulder overall.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.