Shoulder rotator cuff repair may be considered as a surgical treatment option for those patients who have a tear in their rotator cuff, who are experiencing ongoing pain and loss of shoulder function and for those who have had an acute tear or injury of their rotator cuff. The aim of surgical repair of the torn rotator cuff tendon is to minimise shoulder pain and restore shoulder function.
The shoulder joint is a ball and socket type joint, where the humerus (upper arm bone), the ‘ball’, articulates with the scapula (shoulder blade), the ‘socket’. The rotator cuff is a group of four muscles that surround the shoulder joint. These muscles allow the shoulder to move in different directions and importantly they provide stability to the joint. The rotator cuff tendons all attach to the head of the humerus.
There are two types of tears that can occur in the rotator cuff. These are partial and full thickness tears. Partial tears occur in the tendon and can be visualized as fraying of the intact tendon. With a full thickness tear the tendon can be visualized as having a tear through the tendon that can be as small as a pinhole or as large as a fifty-cent piece.
Rotator cuff tears can occur acutely through injury, such as a fall onto an outstretched arm and may also be chronic in nature whereby the tendons are exposed to repeated stress through repetitive movements of the shoulder such as overhead activities or lifting.
A rotator cuff tear can be asymptomatic. The most common symptoms of a rotator cuff tear are a painful shoulder either at rest or with activity and weakness with arm movements to shoulder height and above.
Treatment of rotator cuff repairs is through conservative (non-operative) and operative management. Conservative management of the tear consists of avoidance of aggravating activities (such as work overhead or heavy lifting), the use of anti-inflammatory medications, steroid injection into the shoulder and physiotherapy to strengthen the rotator cuff and increase scapula control.
Surgical repair of the rotator cuff can be performed arthroscopically (‘key hole’) or through an open repair (incision is made and a muscle is moved out of the way to access the torn tendon). Open repairs are usually performed on large or complex tears of the rotator cuff.
Frequently Asked Questions
What are the benefits of a surgical repair of a torn rotator cuff?
The aim of a shoulder rotator cuff repair is to minimise shoulder pain and restore function to the shoulder. Increased function of the shoulder will allow you to perform activities that were previously too painful or your shoulder was too weak to do, such as working at or above shoulder height, reaching forward or to the side, and lifting. Simple activities that were difficult such as combing your hair, or dressing will be much easier after surgery.
What are the risks of a surgical repair of a torn rotator cuff?
The main risks are infection (1%), nerve damage resulting in weakness of the deltoid (rare), numbness over the surgical incision and general risks of an anaesthetic.
Another risk is failure of the repair. The stitches used to re attach the tendon to the bone are very strong, however success of the surgery ultimately relies on the tendon healing back onto the humerus. The risk of failure of the repair increases with advanced age, diabetes, smoking and if you are on blood thinners, such as Warfarin.
How long will I be in hospital for after surgery?
Most patients are in hospital overnight to ensure pain relief is adequate, and for physiotherapy assessment and advice before discharge home.
What can I expect in hospital after surgery?
Most patients who have rotator cuff surgery have a nerve block administered by the anaesthetist before surgery. This usually allows a very comfortable night, however pain relief is given when this block wears off. A physiotherapist will also instruct you on exercises and postoperative shoulder care while in hospital.
How do I look after my wound once I am discharged home?
Your dressing will be changed before you are discharged from hospital if it is wet or blood stained. The dressing should be kept clean and dry till your first post-operative review with Dr Prodger or your GP 10-14 days post surgery.
What rehabilitation will I require after surgery?
For the first two weeks you will do simple exercises prescribed by the physiotherapist in hospital. Depending on the size of the tear and type of repair, you may need to continue these simple exercises for up to 6 weeks.
Ongoing physiotherapy is required for most patients for up to 3 months.
How long will my rehabilitation take after surgery?
Recovery of most function will occur in the first three months, however there may be gradual improvement for up to one-year post surgery.
When can I return to driving after surgery?
For most patients this will be at the six-week mark post surgery.
When can I return to work after surgery?
This depends on your occupation. Office workers can return to work as soon as comfortable, this may be within 2-3 weeks. However manual workers often need considerably longer off work, or a graduated return to normal duties, over a period of months.
When can I return to leisure activities after surgery?
Again, this depends on what you wish to do. Overhead activities and sports usually take at least 3 months to return to. Dr Prodger will advise on particular sports and leisure pursuits.