Rotator cuff repair

Introduction

The rotator cuff is the group of muscles and tendons that stabilise the shoulder.

A rotator cuff tear is very common and can cause great discomfort and pain. Due to the anatomy of the shoulder joint and the surrounding tendons, it is more vulnerable to injury and damage than other joints.

The two main causes of a rotator cuff tear are injury and degeneration.

Injury - Tearing can result from injuries such as a dislocated shoulder, a broken collarbone or repetitive minor injuries when the tendon is damaged. Similarly, any extra strain put on the shoulder could lead to a tear.

Degeneration – As people age the rotator cuff tendon slowly wears down and the blood supply lessons, making the shoulder more susceptible to tearing. Rotator cuff tears are more common in the dominant arm as it is put under continuous stress and repetition. Tears can be caused from overuse and activities such as regular weightlifting, rowing or tennis.

There are two types of tear: a partial tear and a full-thickness tear.

Partial tear – The tear damages the soft tissue, but does not completely separate it.

Full-Thickness tear – The tear splits the tissue into two pieces.

Symptoms

  • Pain when lifting or moving your arm
  • Difficulty or pain rotating your arm
  • The pain is common when resting or at night, often radiating down the arm
  • Unable to lift your arm
  • Crackling sensation when moving your shoulder in certain positions.

Sometimes shoulder cuff tears can be present without any symptoms in older people.

Investigation

  • X-rays
  • Ultrasound scan
  • MRI scan

Early treatment can prevent rotator cuff tears from getting worse and can help to restore function and mobility in the shoulder.

Young people with a tendon tear will normally need to be treated surgically. Older patients with low demands on their shoulders can undergo nonsurgical treatments.

Nonsurgical Treatment

  • Physiotherapy
  • Rest
  • Activity modification
  • Anti-inflammatory medication
  • Steroid injections

Surgical Treatment

  • Keyhole surgery

The operation is performed under general anaesthetic. The surgery helps to create room for the tendons to move and reattaches the tendon to the bone with stitches and bone anchors.

Non-operated management

The main recovery process will include strengthening the remaining rotator cuff muscles.

Weights can be used as resistance to develop a stronger shoulder complex.

Physiotherapy will help to assist shoulder movements and good posture.

Post-operative management

There are three stages following surgery – immobilisation, passive exercise and active exercise.

Initially, the tendons need time to heel and rest.

When your surgeon decides you are ready to start moving your arm, there is an intensive strengthening regime designed to increase power and range of movement in the shoulder.

It begins with gentle movements and postural realignment exercises to put the shoulder into a better position and reduce stiffness.

These gentle exercises will gradually build and increase until the shoulder has full flexibility and range of movement.

Recovery time varies, but it can take several months before you are back doing your everyday activities.