Rotator Cuff Repair Overview
One or more rotator cuff tendons of the shoulder can tear as a result of an acute injury, or wear and tear over time, and this can lead to debilitating pain, weakness, and loss of motion. Many tears can be repaired with an arthroscopic procedure to reattach the torn tendons. A pencil-sized scope and small instruments are inserted through tiny incisions to reattach the torn tendon to the bone. Skin stitches are usually not needed. A sling is worn for about 3 weeks, and physiotherapy and exercise are important to help restore shoulder movement and strength. Several months of relative shoulder protection and exercises are required to allow full healing. In some cases if the tear is chronic, very large, or associated with compromised tendon tissue, a repair is not feasible. Sometimes, however, a “cleaning up” procedure can be done to address primarily the pain component of the condition.
Rotator Cuff Repair Details
The rotator cuff is made up of four tendons and their associated muscles which envelope the shoulder joint, and together with the biceps tendon provide stability and movement of the shoulder. One or more of these tendons can become damaged through injury or degeneration. An MRI is often performed to confirm the diagnosis. A torn rotator cuff can cause shoulder pain, loss of motion, weakness, and dysfunction. In many cases a rotator cuff tear can be repaired, and this is usually done arthroscopically.
Rotator cuff repair is performed as an outpatient procedure under general anaesthetic. Sometimes an additional nerve block is used for post operative pain relief. The procedure is performed arthroscopically, using several tiny incisions for insertion of the scope and instruments. Tendons are reattached to the bone with small anchoring devices. If the tear is too large or the tissue too damaged to allow repair, a partial repair or simply trimming of damaged tissue and bone spurs can provide partial relief of symptoms. A dislocated or torn biceps tendon can be released, which may result in a cosmetically altered biceps muscle but usually improves pain without loss of function.
Skin stitches are usually not needed. Long acting freezing is injected, and a prescription for painkillers is given. Icing is encouraged to assist in pain and swelling control. A sling should be worn for the first three weeks after surgery, and home exercises are given to begin within a day or two of surgery. A referral to physiotherapy will subsequently be made at the first follow up visit.
The rotator cuff is slow to heal, and can take several months to become completely healed. Smoking, excessive activity, diabetes, and poor conditioning can interfere with healing, and re-tear after repair can occur. Rehabilitation is critical for optimal results, and requires diligent adherence to home exercise and physiotherapy programs. Return to activities, including work and sports, varies with the specific procedure, and should be discussed with your surgeon. Even with the best outcomes, it may take up to a year to achieve ultimate improvement and the full benefit of surgery.
The success of surgery cannot be guaranteed, and any operation has potential complications. For rotator cuff repair these include anaesthetic complications, temporary stiffness or frozen shoulder (approximately 1 in 20 cases), infection (1 in 200), blood clots (1 in 1000), nerve damage (very rare) and occasionally re-tear or failure of the repair. Repair usually results in significant improvement, though complete return to a normal shoulder may not be possible.