Rotator Cuff Repair

About rotator cuff repair

There are four tendons that are involved in movement of the shoulder. These tendons are collectively called the rotator cuff. They are attached to the shoulder blade at one end and to the top of the humerus (upper arm) at the other end. They pass through a narrow space just before attaching to the top of the humerus. This space can become increasingly narrow over time due to either formation of a bony spike of bone or thickening of a ligament. This causes increased pressure on the rotator cuff tendons, initially the tendons become inflamed and painful, but if the pressure is not relieved the tendons can become damaged and ultimately they can tear. Normally the uppermost tendon, supraspinatus, tears first and if the tear gets worse the next tendon, infraspinatus, may also tear. The treatment will depend upon the size of the tear.

Generally an MRI scan is done before performing surgery. At the time of surgery a subacromial decompression is performed first to help relieve the pain associated with the tear. The subacromial area is the space between the top of your upper arm bone (humerus) and the small bone attached to the top of your shoulder blade (acromion). Subacromial decompression opens up this space and reduces the pressure on the muscle by cutting the ligament and shaving away the bone spur on the acromion bone, which allows the muscle to heal.

Small tears can be treated by arthroscopic repair, repair through a small incision or if very small can be left untreated. This can be done with an overnight stay in hospital.

Larger tears generally need to be repaired and both arthroscopic and open techniques are used depending on the size and location of your tear. Arthroscopic repairs will involve the use of suture anchors (dissolvable plastic pegs with strong sutures attached) which are placed into the bone and the tendon is then sutured down to the anatomic insertion site. Typically there will be between three and five small incisions to allow this surgery to be performed

For open surgery 4-8cm incision is made on the side of the shoulder and the torn tendon reattached to bone with sutures. This requires a stay in hospital of 1-2 nights. Post-operatively your arm will be placed in a sling, which you will be required to wear for up to six weeks during the healing process.

After surgery

Typically the first three weeks are spent with your arm in a sling with minimal movement. The aim of this phase is to allow the repair to heal strongly. Between three and six weeks physiotherapy may then be started to regain movement in the shoulder, which will be quite stiff by this time. You should typically be able to restart driving after about two months. The final phase is between 8-16 weeks. Strengthening exercises are started as the repair is now strong enough.

If it is deemed appropriate after four months some sports can be restarted, but heavy lifting and contact sports should be avoided until six months after surgery.

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