What is a Rotator Cuff Repair?
Rotator cuff repair is a type of surgery to fix a torn tendon in the shoulder.
The rotator cuff is a group of muscles and tendons that form a cuff over the shoulder joint. These muscles and tendons hold the arm in its “ball and socket” joint and help the shoulder to rotate. The role of the tendons is to hold the powerful shoulder muscles to the shoulder and arm bones. The tendons can be torn from overuse or injury.
The procedure can be done with a large (“open”) incision or with shoulder arthroscopy, which uses small button-hole sized incisions. Most rotator cuff repairs are performed using arthroscopy or ‘key hole surgery’.
Some injuries require that the tendon be reattached directly to a bone in the shoulder, whereas some injuries require the two torn ends of the tendon to be stitched back together. In some instances, when there is only a partial tear in the rotator cuff tendons, the tendons are trimmed down and no major reattachment is necessary.
Who is this operation for?
Not all people who have injured their rotator cuff will require surgery. You may need surgery if you have torn or ruptured your rotator cuff and fit into one of the following categories:
- People suffering from shoulder pain lasting between 6 – 12 months.
- People who have sustained a rotator cuff as a result of trauma – (a fall, sporting injury or a car accident ect).
- People who have rotator cuff tears and have suffered a loss of function or quality of life.
- People who have sustained large tears to their rotator cuff.
What are the benefits of the operation?
This operation is performed to reduce the pain in the shoulder in the long term and improve the strength of the shoulder.
It is also beneficial for people who are engaged in activities that require overhead work, such as swimming, painting, plastering or tennis.
Complications
The complication rate following shoulder cuff repair is very low.However like all surgery, there are risks that need to be considered when deciding to have shoulder cuff repair surgery.
Side effects
Side effects are symptoms that occur due to the surgery and are a normal part of the recovery from the operation. The main side effects of rotator cuff repair are:
- A sore shoulder which may last for several weeks after the operation.
- Swelling of the shoulder which may last for several days.
Complications
Complications are problems that occur during or after the operation. Most people having shoulder cuff repair surgery aren’t affected. There are some complications that may occur for any operation. These include:
- A reaction to the anaesthetic
- Infection of the wound or joint
- Excessive blood loss
- A blood clot, usually in a vein of the leg (known as a deep vein thrombosis or DVT)
Specific complications of shoulder stabilisation arthroscopy are very uncommon, but can include the following:
- Re-ruptures: The tendon that is being fixed may tear again after the operation. This occurs in roughly 10% of people having the operation. It is important that you follow the surgeons advice in order to make sure the chance of this happening is minimised.
- Shoulder stiffness: Occasionally your shoulder may be stiff after this operation. It is important to complete the physiotherapy exercises in order to avoid this.
- Damage to nerves: This occurs very rarely in less than 1% of cases. Damage to nerves can lead to an area of numbness over the shoulder or a weak muscle.
Before the operation
Preadmission Clinic | Preparing for Surgery
Before your operation, you will be seen at the Preadmission clinic to make sure you are fit for the operation and all the necessary tests are performed in preparation for the operation.
During the visit, you will be seen by a
- doctor
- nurse
- anaesthetist (if necessary)
Tests
Tests that may be ordered for you include:
- Blood tests
- Xray of your Chest (if necessary)
- ECG (if necessary)
Preparing Your Skin
Your skin should not have any infections or irritations before surgery. If either is present, contact your orthopaedic surgeon for a program to improve your skin before surgery.
Tip
Carry a list of your medications with you including the name, dosage and how often you take it.
Medications
Our doctors will advise you which medications you should stop or can continue taking before surgery.
Get some help from your friends and family
Whilst recovery from this operation is generally quite fast, you will not be able to use that arm very well during the healing process. You may wish to organise some help from family or friends in daily tasks, such as cooking and driving in the first week or so after the operation.
About the Operation
Admission
Most people are admitted to hospital on the day of their surgery. For a knee arthroscopy you can usually go home on the day of your surgery but some people will need to stay overnight.
Anaesthesia
The anaesthetic team will see you and decide the type of anaesthetic that’s best for you.
The different types of anaesthesia include:
- General Anaesthetic. This type of anaesthetic puts you asleep during the whole procedure and a machine controls your breathing.
- Spinal Anaesthetic. An injection is placed into your back to numb your hip and legs. You will be awake during the procedure, however a sedative can be given to you to help you doze off.
- Nerve Blocks. This special injection is used to help with your pain after the operation and often used in conjunction with a general anaesthetic.
The operation
The operation is usually done via keyhole surgery. This involves making several small cuts around the shoulder, to allow a camera and specialised instruments to be introduced into the joint. By doing this, the surgeon can inspect the rotator cuff and other structures in and around the shoulder joint, in order to assess what needs to be done.
Occasionally the operation is done by making a cut on the front of the shoulder and exposing the shoulder joint.
The torn tendon is reattached with sutures (stitches). Small rivets (called suture anchors) are often used to help attach the tendon to the bone as well. The suture anchors can be made of metal or material that dissolves over time, and do not need to be removed.
There is an arch of bone on top of the shoulder which the rotator cuff tendon slides under. There is sometimes a bone spur here which needs to be shaved in order to ensure the tendon doesn’t tear again.
Once the tendon is repaired, and any other structures such as a bone spur is cleaned up, the skin cuts are then stitched up with sutures and a dressing is placed over the wounds.
The whole operation usually takes 1 – 2 hours to complete.
Recovery Room
After the operation, you will be resting in the recovery room, where specially trained nurses will closely monitor you. This usually takes 1 to 2 hours. After which, you will be taken to your hospital room.
After the Operation
After the operation, you are cared for in the Theatre Recovery room. You will usually only spend 1-2 hours in the recovery room.
Most people wake up fully when back in their rooms on the ward. Whilst on the ward, the nurses will take care of your every need. It usually takes a few hours to recover fully from the anaesthetic, and the nurse with regularly check on your recovery. You may be required to stay 1 night in hospital or you may be able to go home on the day of the operation.
You will need to go home with some pain relief to help with the pain for the first few days.
Recovery and Rehabilitation
For the first 4-6 weeks after the operation, the arm needs to be in a sling to protect it from regular use. During this time, a physiotherapist can outline appropriate exercises that encourage increasing the range of motion of the shoulder. It is important to follow the advice of your surgeon and physiotherapist as your shoulder is vulnerable to re-injury in the first 6 weeks following the operation.
After 6 weeks, exercises that promote strengthening of the muscles around the shoulder are encouraged. Your physiotherapist will give you an exercise program in order to help build up the strength in the shoulder.
It is important to complete the required physiotherapy exercises in order to get the best outcome after the operation.
If you participate in competitive sport it may take 6 months to return to these activities.
F.A.Q.s | Frequently Asked Questions
What are the alternative treatments to having a Rotator Cuff Repair?
Alternatives to surgery include:
- Pain medication
- Cortisone injections
- Physiotherapy
- Rehabilitation exercises
Are there important things I need to tell my doctors?
- Redness, swelling or warmth around the cut
- Leakage from the cut
- Fever and chills.
- Severe knee pain that is not relieved by prescribed painkillers.
- Sudden sharp pain and clicking or popping sound in the knee joint
- Loss of control over leg movement
- Loss of leg movement
- Further surgery planned for the future i.e. dental work, bladder catheterisation, examinations of the bowel, bladder, rectum or stomach.
References
- P. Randelli, P. Spennacchio, V. Ragone . Complications associated with arthroscopic rotator cuff repair: a literature review. Musculoskelet Surg (2012) 96:9–16
- Samuel S. Koo. Stephen S. Burkhart. Rehabilitation Following Arthroscopic Rotator Cuff Repair. Clin Sports Med 29 (2010) 203–211
- Tompkins M, Ma R, Hogan MV, Miller MD. What’s New in Sports Medicine. J Bone Joint Surg Am. 2011 Apr 20;93(8):789-97
- Seida JC, LeBlanc C, Schouten JR, Mousavi SS, Hartling L, Vandermeer B, Tjosvold L, Sheps DM. Systematic review: nonoperative and operative treatments for rotator cuff tears. Ann Intern Med. 2010 Aug 17;153(4):246-55.