Rotator Cuff Repair
Rotator cuff repair is a surgical procedure carried out to repair a torn tendon in the shoulder. The technique can be done with a large (open) incision or with shoulder arthroscopy (keyhole surgery) that uses smaller incisions.
What is a Rotator Cuff?
The rotator cuff is a group of muscles and tendons that connect your upper arm bone (humerus) to your shoulder blades. The rotator cuff also secures the humerus in your shoulder socket. A rotator cuff injury can cause a dull ache in the shoulder that often worsens with use of the arm away from the body. Rotator cuff repair is the surgery used to repair a tear in one of these tendons.
Types of Rotator Cuff Injury
There are a number of conditions that can affect your rotator cuff. These include:
General wear and tear
Rotator cuff injury can be caused by general wear and tear from repetitive movements, or as you get older.
Tendinitis
Tendinitis is a common injury in athletes who participate in overhead sports such as swimming or tennis, caused by inflammation of the tendons in the rotator cuff.
Bursitis
A painful condition caused by inflammation or irritation of the fluid-filled sac (bursa). Bursitis most commonly affects your shoulder joint and rotator cuff tendons, elbow and hip.
Tendon tear
A partial or complete tear caused by an injury or repetitive motion of the tendon connecting the muscle. A torn rotator cuff can cause pain, weakness and restricted range of motion. Small tears can develop in the tendon over a period of time due to general wear and tear.
Shoulder impingement
A common cause of shoulder pain, caused by the rotator cuff catching on the bones in the shoulder. Due to swelling caused by shoulder impingement, you may experience persistent pain. Left untreated, shoulder impingement can lead to rotator cuff tears.
Symptoms and When to Consider Surgery
Rotator cuff injuries are extremely common and can increase with age, generally over the age of 60, due to the rotator cuff becoming irritated or pinched by calcium deposits in the shoulder area, or bone spurs as a result from arthritis. Repetitive stress may cause a rotator cuff injury earlier in life for people who have jobs that require repeatedly carrying out overhead motions such as a painter or window cleaner. This is also the case for sportsmen such as tennis players or swimmers.
Rotator cuff tears can also be caused by a single injury. Medical attention should be sought immediately to examine the damage and decide on the best course of treatment.
The most common symptom of a rotator cuff injury is pain at the top and side of your shoulder. You may experience a dull general ache, or, if in an accident, may feel severe and abrupt pain. The shoulder pain generally gets worse if you are performing overhead movements, or at night, particularly if you sleep on the injured shoulder. Other symptoms of a rotator cuff injury can include:
- Weakness of the shoulder when you lift or move your arm
- Reduced range of motion
- A clicking or grating sound when moving your shoulder
These symptoms may be caused by complications other than a rotator cuff injury. If you show signs of any of these symptoms, contact your doctor for advice.
Signs that you may require rotator cuff repair surgery include:
- You have experienced symptoms for 6 – 12 months
- You are affected by weakness that limits the functionality of your shoulder
- Your symptoms have resulted from a recent injury
- You are an athlete
Your doctor may suggest rotator cuff repair surgery as an option for a torn rotator cuff if your symptoms do not improve with nonsurgical techniques.
Diagnosis
Your doctor will ask about your symptoms and take a full medical history. A physical examination will then be performed, where your doctor will apply pressure to different parts of your shoulder whilst moving your arm into different positions to determine how well your shoulder is working. They will also test the strength of the muscles around your shoulder and in your arms.
Your doctor may then suggest imaging tests to confirm the diagnosis. These tests may include:
X-rays
X-rays are used to produce images of tissues and structures inside the body. A rotator cuff tear will not show up on an X-ray; however, the test will show bone spurs or other possible causes for your pain, such as arthritis.
Ultrasound Scan
Ultrasound scans use high-frequency sound waves that form an image of the inside of the body.
Magnetic Resonance Imaging (MRI) Scan
MRI scans use radio waves and magnetic fields to take pictures of the structures and organs inside the body.
Following your physical examination and imaging tests, your doctor will decide whether rotator cuff repair surgery is the best treatment option for you.
If surgery is an option for you, your doctor may want to examine your shoulder further by using an arthroscope. During an arthroscopy, a mini camera (arthroscope) is used to view the rotator cuff. Your doctor may give you a numbing agent before inserting the camera. The images of your tendons, ligaments and cartilage all show up on the video monitor, allowing your doctor to determine whether surgery will help cure the problem.
Treatment
Surgery is generally not the first course of treatment for shoulder injuries. Your doctor may first suggest rest, applying ice packs, over the counter painkillers, steroid injections or physical therapy. In some cases, if the injury is not extreme, these treatment methods may be enough. However, if a tendon is torn, exercise and rest can decrease the pain, but will not repair the tear.
At home care
Rest your shoulder as much as you can and avoid lifting heavy weights or taking part in activities that involve lifting your arm above your head. Appling an ice pack can help to reduce the pain, along with pain relief medication such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your doctor for advice.
Steroid Injections
If conservative treatments have not reduced your pain, you are experiencing reduced range of motion or the pain is interfering with your sleep and daily activities, your doctor might recommend a steroid injection into your shoulder joint. The injection can help to reduce swelling, pain and stiffness; easing symptoms and discomfort to make daily activities more comfortable. However, steroid injections can cause your pain to initially get worse, along with contributing to the weakening of the tendon. They may also lower the success of surgery if eventually required. It is recommended that you have no more than 4 injections a year to avoid muscle weakness.
Rest and Physical Therapy
Rest and physical therapy is usually the first line of treatment for rotator cuff injuries. Your physiotherapist will give you specific exercises and stretches to do at home to help improve strength, flexibility and movement in your shoulder. Depending on the severity of your injury, physical therapy may be essential for several weeks to months. Physical therapy is also an important part of the recovery process after rotator cuff surgery.
Surgery
Rotator cuff repair surgery may be suggested if all other treatments have failed, or if you have a large tear. Treatment for a rotator cuff injury aims to reduce pain and give you as much mobility in your shoulder as possible.
There are a number of surgical techniques available to repair a rotator cuff, with the best method chosen depending on several factors. These include the size of your tear, your overall health, and the quality of the tendon tissue and bone. Many surgical repairs can be performed on an day case basis and do not require an overnight stay in the hospital. Surgical techniques available include:
Arthroscopic Tendon Repair
Typically performed as a day case procedure and the least invasive technique. Surgery involves the doctor inserting a small camera (arthroscope) and surgical tools through a tiny incision to reattach the torn tendon to the bone. The arthroscope is connected to a video monitor in the operating theatre that displays the images on a screen and allows the doctor to assess the inside of the shoulder and guide the surgical tools.
Open Tendon Repair
Open tendon repair is a traditional technique generally used when the tear is large or complex. During the procedure, your doctor works through a larger incision over the shoulder and detaches one of the shoulder muscles to assess and reattach the damaged tendon to the bone. An open repair may be a good option if additional reconstruction, such as a tendon transfer, is likely.
Tendon Transfer
In extreme cases, if the torn tendon is too damaged to be reattached to the arm bone, your surgeon may move a tendon from one nearby location to another as a replacement.
Shoulder Replacement
Severe rotator cuff injuries may require shoulder replacement surgery. The procedure involves removing the damaged area and replacing it with an artificial joint. To improve the artificial joint’s stability, the ball part of the artificial joint is installed onto the shoulder blade and the socket part onto the arm bone.
Recovery from Rotator Cuff Repair
Whatever surgical technique your doctor decides upon, you should expect to be in a sling for around 6 weeks in order to protect your shoulder and allow the rotator cuff time to heal.
You may experience some pain following the surgery and it can take several weeks to months before your shoulder starts feeling better. Pain can be managed with over the counter painkillers.
You will likely have a follow-up appointment booked for around 10 days following your procedure where you will also have any stitches removed from your shoulder. Before they are removed, it is important to keep the incision clean and dry to avoid infection.
Physical therapy is an important step in your recovery. Daily exercises will be provided by a physiotherapist after your procedure, and you will be required to begin them within 24 hours following surgery to avoid conditions such as frozen shoulder. These exercises are provided to help build strength, flexibility and range of motion, and it is important that you continue with them upon discharge from the hospital.
Recovery from rotator cuff repair surgery can be difficult and takes time; however, most people are back to their everyday routine within 3 – 6 months, depending on the extent of their condition and surgery.
Risks and Complications
Every surgical procedure comes with a certain level of risk that can include:
- Nerve damage
- Infection
- Excessive bleeding or clotting
- Allergic reaction to the anaesthetic
- Brething difficulties during the operation
After rotator cuff repair surgery, a small percentage of patients experience complications with the majority of cases showing improved strength and reduced pain. However, some patients will experience stiffness that can last for 6 – 12 months.
Although rare in most cases, your cuff repair can tear, with the level of risk increasing with the size of the original injury.
Resting your shoulder is an important step during recovery, but keeping your shoulder immobilised for a prolonged period of time may cause the connective tissue around the joint to thicken and tighten leading to frozen shoulder.
Outlook after Surgery
Results following rotator cuff repair surgery to relieve pain are often successful. With physical therapy, you can expect to recover shoulder function, but you may still have signs of weakness or stiffness in the long-term.
Rotator cuff repair surgery may entail a long recovery process, particularly if the tear was large. The time it takes to return to work, sports or driving differs depending on the surgery that was performed, but you should expect recovery to take several months before you are fully carrying out your regular activities again.
Need Help?
In addition to rotator cuff repair, we perform a number of different shoulder surgeries at One Ashford Hospital, including labrum repair, shoulder stabilisation surgery and shoulder replacement surgery. We can book you in to see a Consultant Orthopaedic Shoulder Surgeon for an initial consultation, usually within 48 hours.
One Ashford Hospital is ideally placed to see patients based in Ashford, Kent, Maidstone, Dover, Canterbury, Folkestone and all nearby areas. To find out more, contact the hospital on 01233 423000
You can use your private medical insurance or pay for your Rotator Cuff Repair treatment. We offer competitive, fixed price packages. If you are using your health insurance, please contact your insurer first for approval and let them know you’d like to be treated at One Ashford Hospital
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- Specialist Physiotherapy and nursing teams
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