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Rotator Cuff Repair

There are 4 tendons that move 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 narrowed further over time due to either a bony spike developing or thickening of a ligament. This causes increased pressure on the rotator cuff tendons, initially they get inflamed and painful, but if the pressure is not relieved the tendons can get damaged and ultimately they can tear. Normally the uppermost tendon, supraspinatus, tears first and if the tear gets worse the next tendon, infraspinatus, tears as well. The treatment depends upon the size of the tear.

Operative management

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.

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

Larger tears generally need to be repaired and usually an open technique is used. A 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.

Pain in generally controlled by a nerve block in the base of the neck. Post operatively your arm will be placed in a sling, which will be needed for up to 4 weeks.

Post Operative Management

The first 4 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 4-8 weeks physiotherapy is started to regain movement in the shoulder, which will be quite stiff by this time. You should be able to restart driving mid way during this phase. The final phase is between 8-16 weeks. Strengthening exercises are started as the repair is now strong enough.

After 4 months some sports can be restarted, but heavy lifting and contact sports should be avoided until 6 months after surgery.

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