Rotator Cuff Repair

Why does it occur?

The rotator cuff is a group of four tendons/muscles enveloping the shoulder joint. As we get older the tendons can get weaker, eventually the tendon can be weakened to the point that it tears with minimal injury or force. Patients often report problems after a minor fall or stumble, sometimes pulling on a stubborn plant in the garden or even pulling up the bed clothes awkwardly can cause a rotator cuff tear. Younger people with healthier rotator cuff tendons can tear them but this tends to be with a more significant injury. A torn rotator cuff tendon cannot heal itself without being surgically repaired.

What are the symptoms?

Symptoms vary between patients, indeed many people have a rotator cuff tear and hardly notice any symptoms or functional loss. Most people notice pain and difficulty using the arm in positions away from the body or over head. Small tears can be painful and large tears can de-function the remaining rotator cuff muscles such that the shoulder is so weak it appears paralysed and the patient can only shrug the shoulder.

Investigations

A rotator cuff tear is usually suspect from the patients history and examination. Ultrasound and MRI scans can be used to confirm a tear and assess its size and whether it is repairable

Treatment options

  • Non-operative treatment

Steroid injections can damp down pain when this is a major feature

Physiotherapy can help strengthen remaining muscles to compensate and restore function.

Occasionally patients not suitable for surgery can be helped by nerve blocks after an assessment in the pain clinic

  • Operative treatment

Rotator cuff repair is usually performed arthroscopically (key hole surgery). Open surgery is often required for very large tears.  Surgery can be done as a daycase or with an over night stay. With both techniques sutures are placed in the tendon and these are used to fix the tendon back to the bone, usually with anchors drilled into the bone.

Complications

Infection is very uncommon after arthroscopic surgery.  Open surgery has a higher incidence of infection of around 1%. Stiffness can occur after all shoulder surgery and the post operative rehabilitation program aims to minimise this while protecting the repair. Occasionally tears are not repairable and sometimes a tear fails to heal after a repair. In these cases the shoulder can still be better than it was before surgery.

Rehabilitation after surgery

After a rotator cuff  repair you will be in a sling for 6 weeks. You will be given an early exercise program to prevent stiffness and will be allowed out of the sling when safe at home. Towards the end of the first 6 weeks your physiotherapist will start more active exercises to regain movement and strength

Frequently asked questions

When can I drive a car?

You must not drive while in a sling. After the sling is removed you will have a stiff and weak shoulder and may not be fit to drive for several weeks. You must be confident that you have regained enough function in your shoulder before driving again.